Summary
Work History
Education
Skills
Accomplishments
Certification
References
Timeline
Generic

Karen Stearns

Marietta,GA

Summary

Workers’ Compensation claims professional leveraging over 20 years in the industry. Strengths in leadership, customer service, networking and nationwide claims management. Utilizing my experience on the Carrier and Third-Party Administrator side, as well as on the Employer side, has given me a diverse perspective and multitude of proficiencies.

Work History

Manager, WC Claims Department

TriNet PROFESSIONAl Employer Organization
09.2018 - Current
  • Provides oversight and leadership to a group of 5 Analysts and additional support as needed to the Director of WC Claims and the Executive Leadership team
  • Duties include providing oversight and collaboration with the Third-Party Administrator (TPA), reserve authorization which exceeds the Analysts authority level, extra support when necessary and daily mentorship for the national workers’ compensation program offered to client’s across the United States
  • Participates in conference calls with Carriers CHUBB/Zurich/AIG), Defense Attorneys and Adjusters to work towards claim resolution
  • Responsible for hiring and onboarding new colleagues and mentoring them to success
  • Coordinates and/or provides additional training within team as needed
  • Initiates and manages performance plans when necessary and termination when all efforts exhausted, Collaborates with other internal departments including Risk Mitigation (Loss Control), Account Management, Legal/EPL, Client Services, Pricing, Sales and Executive Leadership
  • Assists in identifying high risk clients/employers and aids in or leads training and education for them to maintain retention
  • Responsible for vendor management including medical, investigative, and legal to include fee negotiation, identifying new additions to the program and removing those that are no longer the right fit
  • Overall, daily goal is to ensure that the client is receiving the best service as possible by managing a team of incredible professionals and providing the support necessary to do so.

WC Claims Examiner III

Sedgwick
03.2008 - 06.2016
  • Claims handling duties for jurisdictions in Colorado, Utah, and Arizona
  • Typical responsibilities included, but not limited to, compensability determination, timely indemnity payments, prompt filing of state forms, monitoring and responding to legal activity, which included attending depositions and mediations
  • Strategized with defense counsel, conducted settlement negotiations, employer communications, injured worker trust development, in-person and telephonic claim reviews
  • Overall claims management to bring claims to timely and cost-effective resolution.

Senior Claims Adjuster

Unisource Administrators
06.2007 - 03.2008
  • Typical claims handling duties, as previously described, specific to Florida jurisdiction
  • This desk was responsible for managing catastrophic claims as well as a large carrier (AIG) account that possessed a multitude of ongoing, high dollar claims that required close attention and creativity to move to closure
  • The claims were heavily litigated and required extreme sensitivity due to age, cost and severity of the injuries.

Claims Supervisor Large Deductible/Self-Insured Department

FCCI Insurance Carrier
01.2000 - 01.2003
  • Supervised 8-10 adjusters
  • In addition, continued to maintain a reduced case load
  • Attended on-site file reviews, audited the adjusters’ files to find areas for improvement and assistance to move claims towards closure; provided settlement authority and overall guidance and mentorship to team
  • Conducted semi-annual and annual performance reviews and addressed other HR/performance issues as necessary.

File Clerk, Claims Assistant, Claims Adjuster Trainee, Claims Adjuster, Senior Claims Adjuster

FCCI Insurance Carrier
01.1993 - 01.2000
  • After training program completed, assumed a regular case load and began to work in the Large Deductible/Self-Insured Department
  • This department managed claims for the most demanding and highest profile clients
  • Performed all regular adjuster duties and attended in-person claim reviews for each client.

Claims Adjuster II

FCCI Insurance Carrier
01.2003
  • This role entailed managing a full caseload of claims with multiple employers
  • In addition, responsible for providing leadership and training to adjusters that were in a trainee program (6 month intense training for incoming adjusters)
  • Participated in management breakout groups to brainstorm and implement new processes to improve the Claims Department.

Senior Analyst WC Claims Department

TriNet PROFESSIONAl Employer Organization
  • As a Senior Analyst, collaborated directly with the Adjusters at the TPA to ensure effective claim handling and ultimate timely and cost-effective claim resolution
  • Jurisdiction was Nationwide working with the highest profile clients/employers in the TriNet book of business
  • Conducted telephonic and in-person claim reviews in a highly client-facing role
  • Collaborated with the Adjusters as well as Defense, Risk Mitigation, Carriers, Legal and Client Services.

Education

Some College (No Degree) - Business Administration

State College of Florida, Manatee-Sarasota
Bradenton, FL

Skills

  • Time Management/Multi-Tasking/Calm under pressure
  • Situationally adaptive with people and challenges
  • Highly effective communicator, collaborator and interpersonal skills
  • Problem Solver
  • Inclusive and encouraging leader
  • Self-motivated
  • Results Driven
  • Negotiation
  • Customer service/client satisfaction
  • Efficient

Accomplishments

  • Participated as a speaker at the National WC & Disability Conference 2019 on cross-jurisdictional issues that effect the WC industry, specifically from the employer’s perspective.
  • Established new and updated goals and procedures for the WC Claims Department at TriNet as well as tracking metrics across the department to provide data and accountability
  • Restructured defense legal panel nationwide at TriNet, to include establishing new firms and rates which entailed extensive research, communication and negotiation
  • Nominated by management to participate in leadership program. Completed September 2020
  • Currently enrolled in Associate in Risk Management (ARM) course and studying towards completion.

Certification

  • Currently working towards ARM-

References

References available upon request.

Timeline

Manager, WC Claims Department

TriNet PROFESSIONAl Employer Organization
09.2018 - Current

WC Claims Examiner III

Sedgwick
03.2008 - 06.2016

Senior Claims Adjuster

Unisource Administrators
06.2007 - 03.2008

Claims Adjuster II

FCCI Insurance Carrier
01.2003

Claims Supervisor Large Deductible/Self-Insured Department

FCCI Insurance Carrier
01.2000 - 01.2003

File Clerk, Claims Assistant, Claims Adjuster Trainee, Claims Adjuster, Senior Claims Adjuster

FCCI Insurance Carrier
01.1993 - 01.2000

Senior Analyst WC Claims Department

TriNet PROFESSIONAl Employer Organization

Some College (No Degree) - Business Administration

State College of Florida, Manatee-Sarasota
Karen Stearns