Open To Work
LEANNE BATISTE
Princeton,TX
Work Preference
Summary
Results-driven Workers' Compensation Claims Adjuster experienced in managing complex claims from intake to resolution. Achieved significant improvements in claims processing through thorough investigations, effective collaboration with legal counsel, and strategic negotiations. Focused on ensuring regulatory compliance and enhancing customer satisfaction by delivering timely settlements.
Overview
10
10
years of professional experience
Work History
Non-Subscriber Claims Specialist II
BAYLOR, SCOTT & WHITE SAFE CHOICE
Dallas
2025.05 - Current
- Administer complex non-subscriber occupational injury claims from intake through resolution, conducting thorough investigations to assess liability, causation, and exposure.
- Collaborate closely with legal counsel, HR, and risk management to evaluate compensability, mitigate financial risk, and support pre-litigation and litigation strategy.
- Analyze medical records, wage documentation, and incident reports to determine benefit eligibility and negotiate timely, cost-effective settlements.
- Serve as a senior resource for escalated claims, guiding peers on coverage analysis, documentation standards, and regulatory compliance.
- Spearhead process improvement initiatives that strengthened documentation accuracy, enhanced claim cycle time, and optimized overall claims workflow efficiency.
Founder and HR Executive
JANNY BEES INC.
Little Elm
2022.03 - Current
- Established the vision and strategic direction of the organization as the founder of a nonprofit entity.
- Ensured the smooth execution of all necessary administrative functions.
- Played a pivotal role in the selection of board members and defined their responsibilities in establishing organizational policies.
- Implemented policies set forth by the board and approved annual operating budgets.
- Determined staff salaries, authorized contracts, and managed major expenditures impacting the organization's finances.
- Oversaw the organization's financial health and represented its interests to the public, donors, and other stakeholders.
- Supervised the work of board committees and monitored the performance of external professionals and consultants.
- Directed the daily operations of the organization.
- Spearheaded the HR management process by developing company policies, recruiting executives and managers, and creating training materials that contributed to a 90% staff retention rate.
Workers Compensation Case Manager II
WALMART CLAIMS SERVICES
Carrollton
2023.02 - 2025.06
- Managed workers' compensation claims within top-tier reserve limit of $150k, controlling financial aspects by establishing proper reserves and authorizing payment or facilitating denial of claims.
- Directed the associate disability management team, including 13 direct reports, participating in case reviews and supporting the implementation of business solutions.
- Acted as an altruistic servant leader, proactively seeking improvements while prioritizing customer focus, building diverse and inclusive teams, fostering strong relationships, and communicating with energy and positivity to inspire commitment.
- Negotiated claims with minimal supervision and provided exceptional service to customers by sharing information, discussing resolution strategies, and developing relationships with cross-functional teams.
- Investigated facts for complex workers' compensation claims, determined compensability, evaluated medical records, and utilized medical and legal resources to achieve maximum medical improvement (MMI).
- Ensured compliance with company policies and procedures and demonstrated up-to-date expertise in the development and execution of action plans.
- Resolved compensation claims by reviewing case data, applying knowledge of company, state, and federal policies and labor regulations, and monitoring disability and diversity management programs to ensure fair compensation.
Sr. PIP / MPC Claims Specialist
STATE FARM
Richardson
2022.06 - 2023.02
- Managed Nevada MPC and Michigan PIP claims involving fractures, mild closed head injuries, surgical procedures, and attendant care.
- Liaised with insured parties, physicians' offices, and medical insurance carriers to procure essential information for claim reviews.
- Examined assigned claims, established clear expectations with insured parties, performed complex coverage analysis, identified policyholder benefits, and initiated sub-claims as needed.
- Conducted comprehensive investigations to ascertain claim eligibility, assessed damages based on state law and other factors, evaluated the financial value of losses, and approved payments accordingly.
- Demonstrated strong negotiation capabilities and efficiently documented and coded claim files, ensuring completion of all closure tasks within the claims management system.
Liability Claims Manager II
ROOT INSURANCE
Remote
2021.06 - 2022.06
- Handled intricate coverage and liability claims.
- Gathered requisite information to assess liability, damages, and potential injury exposure, and rendered coverage decisions based on policy language.
- Prioritized the determination of coverage and liability exposure during communications with insured individuals or claimants.
- Managed first-call injury settlement claims and claims involving minor injuries.
- Maintained accurate reserves on pending claims and potential exposures, contributing to cost control and adherence to the company's reserving philosophy.
- Consistently achieved general file handling goals and procedures, including maintaining a 1:1 closing ratio and actively participating in diary reviews.
- Leveraged underwriting and policy systems and actively pursued opportunities for skill enhancement through seminars and classes.
- Committed to continuous learning and actively sought to improve claims investigation and evaluation capabilities.
Sr. LTD Claim Analyst
CIGNA/NEW YORK LIFE INSURANCE
Plano
2020.06 - 2021.06
- Managed a portfolio of 130 long-term disability claims by developing comprehensive action plans to mitigate claim risk.
- Utilized internal resources and critical thinking to determine customer eligibility based on contractual language and medical documentation.
- Provided continuous customer service to claimants and internal partners, ensuring timely responses and adherence to customer service protocols.
- Met established timeframes for processing mail, tasks, and phone calls with a strong emphasis on customer satisfaction.
Sr. Total Loss Adjuster
LIBERTY MUTUAL INSURANCE
Plano
2017.10 - 2020.06
- Investigated and resolved complex total loss claims, employing compelling communication skills to gather information from policyholders, witnesses, and claimants.
- Guided claimants and policyholders on appropriate actions based on liability and coverage determinations.
- Settled claims within prescribed authority and statutory limitations, ensuring timely payments.
- Conducted accurate research on inventory validation and pricing through third-party vendors and online resources, and assessed appraisal reports for repairs.
- Maintained thorough documentation and organization of claim information records and reports.
- Trained and coached subordinate employees on new protocols and techniques to enhance performance.
- Identified potentially fraudulent claims utilizing the ISO ClaimSearch database.
Sr. Customer Service Representative (Temporary)
VERIZON WIRELESS
Rolling Meadow
2017.07 - 2017.10
- Responded to incoming calls and emails from customers and engineers, initiating and investigating new and existing cases with outstanding issues.
- Identified customer needs and endeavored to resolve them during the call duration.
- Performed troubleshooting and escalated cases to engineers when necessary.
- Followed up with internal and external personnel to ensure prompt resolution of customer concerns.
- Ensured compliance with company policy in identifying and escalating engineering issues.
- Coordinated with engineering subcontractors for service call scheduling.
- Collaborated closely with internal development, finance, and sales teams to efficiently resolve or escalate cases.
Sr. Customer Service Representative
GROUPON
Chicago
2016.10 - 2017.10
- Served as the primary point of contact for resolving customer issues and escalated concerns in the absence of a supervisor.
- Conducted troubleshooting for various customer concerns related to internet, purchasing, and billing.
- Supervised individual and team activities, evaluated outcomes to identify areas for improvement, and provided coaching as needed to optimize performance.
- Met or exceeded weekly metric goals and achieved the highest call handling rate in the call center.
- Provided exceptional training and support to all communication representatives for general inquiries and guidance.
HR Generalist (Temporary)
MODIS
Chicago
2016.05 - 2016.08
- Administered employee compensation and benefits utilizing Workday HRIS.
- Played a key role in new hire onboarding and designed effective training and development programs.
- Contributed to talent recruitment and acquisition efforts, as well as performance evaluation and management.
- Collected and evaluated data using HR metrics to determine employee turnover rates and hiring needs.
- Participated in ensuring compliance with labor regulations and assisted in formulating and executing human resources policies.
Workers Compensation Associate (Temporary)
ZURICH INSURANCE
Schaumburg
2016.02 - 2016.05
- Reviewed and analyzed non-subscriber claims for compliance with regulations and policies.
- Streamlined documentation and submission of claims, ensuring timely processing and compliance.
- Communicated with injured workers, employers, and medical providers to gather information and resolve issues.
- Conducted preliminary investigations into validity of claims, enhancing accuracy of claim assessments.
- Facilitated claim handling for Addison, TX location, contributing to efficient claims processing.
- Assisted legal teams with address disputes and ensured compliance with state laws.
- Provided customer support to injured workers throughout the claims process.
- Aided in training new staff on administrative processes related to non-subscriber claims.
- Provided administrative support to the claims team, including data entry, filing, and document retrieval.
Education
Master of Science - Human Resource Management
STRAYER UNIVERSITY
DallasBachelor - Business Administration and Management
STRAYER UNIVERSITY
DallasAssociate of Business Administration and Management -
HAROLD WASHINGTON COLLEGE, CITY COLLEGE OF CHICAGO
ChicagoSkills
- Claims Adjuster Certification
- Texas Workers' Compensation Claims Handling
- Texas Jurisdictional Requirements
- Claims Handling Experience
- Claims administration
- Claim Management
- Claims investigation
- Subrogation Identification
- Claim Reporting
- Settlement negotiation
- Claims Financial Review
- Coverage analysis
- Fraud detection
- Claims settlement
- Claims Processing System
- Claims Management Software
- Regulatory Compliance
- Legal compliance
- Statutory Filings
- Documentation management
- Report and records review
- Property damage assessment
- Damage assessment
- Cost analysis
- Medical Treatment Evaluation
- Injury Management
- Workers' compensation laws mastery
- Policy interpretation
- Return-to-work strategies
- Case coordination
- Case reserving accuracy
- Claims Team Collaboration
- Process improvement
- Data analysis
- Information gathering
- Information sourcing
- Research techniques
- Communication
- Effective communication
- Written communication
- Verbal communication
- Conflict resolution
- Professional Judgment
- Critical thinking
- Decision-making
- Complex Problem-solving
- Problem-Solving
- Problem-solving aptitude
- Time Management
- Organizational Skills
- Prioritization skills
- Multitasking
- Reliability
- Empathy
- Interpersonal skills
- Interpersonal savvy
- Team collaboration aptitude
- Inclusive teamwork
- Customer service
- Team Training
- Support litigation
- Litigation support
- Claims Marketing
- Claims Financial Analysis
- Claims Assessment
- Claims
- Claims checking
- Automobile claims specialist
- Investigation techniques
- Investigation reporting
- Expense control
- Negotiate settlements
- Strategic Decision-making
- Magnify predictive targeting system
- ACPC candidate
- Professional Development
- Ethical conduct standards
- Investigation techniques
- Expense control
- Negotiate settlements
- Claims Processing System
- ACPC candidate
- Problem-solving aptitude
- Support litigation
- Information gathering
- Automobile claims specialist
- Interpersonal skills
- Claims Certification
- Multitasking
- Claims Marketing
- Claims checking
- Claims Financial Analysis
- Multitasking
- Communication skills
- Verbal communication
- Prioritization skills
- Magnify predictive targeting system
- Decision-making
Timeline
Non-Subscriber Claims Specialist II
BAYLOR, SCOTT & WHITE SAFE CHOICE
2025.05 - Current
Workers Compensation Case Manager II
WALMART CLAIMS SERVICES
2023.02 - 2025.06
Sr. PIP / MPC Claims Specialist
STATE FARM
2022.06 - 2023.02
Founder and HR Executive
JANNY BEES INC.
2022.03 - Current
Liability Claims Manager II
ROOT INSURANCE
2021.06 - 2022.06
Sr. LTD Claim Analyst
CIGNA/NEW YORK LIFE INSURANCE
2020.06 - 2021.06
Sr. Total Loss Adjuster
LIBERTY MUTUAL INSURANCE
2017.10 - 2020.06
Sr. Customer Service Representative (Temporary)
VERIZON WIRELESS
2017.07 - 2017.10
Sr. Customer Service Representative
GROUPON
2016.10 - 2017.10
HR Generalist (Temporary)
MODIS
2016.05 - 2016.08
Workers Compensation Associate (Temporary)
ZURICH INSURANCE
2016.02 - 2016.05
Master of Science - Human Resource Management
STRAYER UNIVERSITY
Bachelor - Business Administration and Management
STRAYER UNIVERSITY
Associate of Business Administration and Management -
HAROLD WASHINGTON COLLEGE, CITY COLLEGE OF CHICAGO