Karen Burgess
Charleston,WV
Summary
Dedicated, detailed oriented workers' compensation professional experienced with managing claims and supervising teams in multiple jurisdictions.
Overview
28
28
years of professional experience
Work History
Workers' Compensation Claims Supervisor
CorVel Corporation
02.2022 - Current
- Monitors and directs team performance for a dedicated municipality account.
- Leads team of five claims associates dedicated to delivering excellent customer service and timely claim resolutions.
- Maintains claim closure ratio of over 105%.
- Performs internal quality audits and training.
- Ensures compliance with the client's special handling instructions.
- Adheres to jurisdictional requirements (EDI, form filings) - 0 penalties have been assessed since I began managing the team.
- Completes timely notifications to the Excess Carrier.
- Develops training materials to assist the team and client.
Senior Claims Specialist
CorVel Corporation
11.2019 - 02.2022
- Managed case load of 120 -150 claims.
- Investigated claims, determined compensability and established pro-active action plans.
- Calculated benefits and ensured timely delivery; established appropriate reserves (probable, ultimate costs).
- Ensured compliance with internal, external and jurisdictional requirements and handles subrogation matters.
- Provided excellent, quality service to clients, providers and injured workers.
- Achieved internal quality audit score of 90% or higher each quarter.
WC Operations Specialist
York Risk Services
01.2016 - 11.2019
- Oversight of ME, NY, NJ, WV, VA, SC, NC, KY, DE and DC claims
- Completed supervisor reviews (strong focus on AWW/CR calculations, timely indemnity payments, form filings, reserve adequacy, client/carrier compliance & action plans)
- Performed monthly quality audits of team
- Worked with adjusters to increase closure rates
- Participated in client claim reviews - in person and telephonically
- Organized and leads bi-weekly call with largest Carrier
- Developed pro-active action plans to move claims to resolution
- Handled adjuster desk when there were staffing vacancies
- Responsible for on-boarding and training new employees
- Conducted quality training to ensure compliance with jurisdictions, audits and Best Practices
- Generated and utilized management reports to detect any deficiencies
- Assisted with and participated in National Claim Reviews
- Worked with teams to ensure closing ratio of 102% or higher
- Completed targeted reviews on claims open more than 12 months and applied resolution strategies
- Ensured compliance with Carrier reporting
Assistant Vice President
York Risk Service Group
05.2012 - 12.2015
- Managed team of over 40 employees consisting of managers, adjusters and support personnel located in WV, PA, KY, VA and NJ
- Ensured compliance with corporate directives and work flow processes; minimized leakage; drove high closing ratios
- Handled HR related matters; hiring, counseling, performance evaluations and terminations
- Complied with multi-jurisdictional laws and regulations including State Filings and EDI requirements; handled internal/external audits
Office Manager
York Risk Service Group
11.2004 - 05.2012
- Managed team of adjusters and support personnel in WV office.
- Implemented EDI processes.
- Developed office budget.
- Responsible for hiring and performance management.
Adjuster
York Risk Service Group
05.1998 - 11.2004
- Verified coverage, investigated claims, made compensability determinations and established pro- active action plans
- Calculated benefits and ensured timely delivery; established appropriate reserves (probable, ultimate costs)
- Ensured compliance with internal, external and jurisdictional requirements and participated in client claim reviews
Group Rating Analyst
York Risk Service Group
12.1994 - 05.1998
- Reviewed policy holders and assessed risk
- Pooled policies/employers into groups to maximize savings
- Evaluated employers for various cost-saving programs - Self Insurance, Retrospective Rating, etc.
Education
Bachelor's - Elementary Education and Mathematics
WV State University - Institute
Institute, WVSkills
Customer Service
Timely Investigations
Medical Management
RTW Strategies
State & Carrier Compliance
Diary Management
Timeline
Workers' Compensation Claims Supervisor
CorVel Corporation
02.2022 - Current
Senior Claims Specialist
CorVel Corporation
11.2019 - 02.2022
WC Operations Specialist
York Risk Services
01.2016 - 11.2019
Assistant Vice President
York Risk Service Group
05.2012 - 12.2015
Office Manager
York Risk Service Group
11.2004 - 05.2012
Adjuster
York Risk Service Group
05.1998 - 11.2004
Group Rating Analyst
York Risk Service Group
12.1994 - 05.1998
Bachelor's - Elementary Education and Mathematics
WV State University - Institute
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