Daniel Pettyjohn, Aic, Arm Email & Phone Number

Richmond, Virginia, United States

Richmond, Virginia, United States

Richmond, Virginia Area

✔ Investigate, evaluate, and negotiate WC claims for coverage, compensability, and reasonableness of medical care.✔ Conduct root cause analysis and claim reporting to Underwriting / Client Management including evaluation of medical treatment, disability projections, and recommendations to mitigate exposure✔ Manage large claim volume of Homeowner Property claims related to Hurricanes Sally and Zeta to include coverage and damage evaluations. ✔ Finalize payment calculations and supporting Proof of Loss or Denial correspondence to provide expeditious, thorough and courteous customer service. ✔ Quality Assurance of coding, financial exposure and medical records management

Glen Allen, Virginia, United States

Promoted to claims manager taking on portfolio of 3,500 open workers’ compensation claims for 125 VA and D.C. Self-insured and Carrier Deductible clients; supervisory oversight for 31 employees across four teams.✔ Spearheaded cost-savings initiative; partnered with new client risk manager and defense counsel to develop and implement a modernized business process to improve technical skills, claim handling quality, and accuracy standards; ✔ Mitigated legal exposure by driving timely issue resolution and successful defense strategies✔ Decreased medical indemnity and expense payments by 36% ($7.9M) over four years✔ Implemented performance-based metrics to drive accountability, enhance productivity, and ensure regulatory guidelines were met; improved compliance by more than 50% and increased overall customer satisfaction ✔ Advanced company efforts to improve customer service and retention through the creation of an Excel spreadsheet to track and manage claims operations; grew customer base by over 300% in just two years

Glen Allen, Virginia, United States

Managed a team of six claim specialists responsible for adjudicating 1K open workers’ compensation claims for 40+ Self-Insured and Carrier Deductible clients.✔ Attained goal of 100% closing ratio YoY ✔ Leveraged coverage and liability evaluations to identify and pursue subrogation opportunities and maximize recovery

Richmond, Virginia Area

Led team of five homeowner and commercial property claim examiners; accountable for the review and control of the unit’s claim activities including an average annual inventory of 1K+ claims.✔ Coordinated and managed state-wide response to Hurricanes Irene/Lee (2011) and Hurricane Derecho (2012):👉 Conducted quality assurance file reviews to ensure timely diary management and monitored customer satisfaction to drive action plans for improvement👉 Facilitated resolution of additional Hurricane claims workload - 1K [Irene/Lee] and 350 [Derecho] ✔ Quickly identified root-cause problems impeding production and obsolete procedures, resulting in accelerated claim settlements and more consistent qualitative results✔ Streamlined claim routing efficiency by eliminating exclusive outsourcing to a third-party administrator and optimizing internal electronic claim system functionality: 👉 Collaborated with IT leaders and executive management to redesign electronic claim system for routing of claims based upon loss type, severity, and geographic location👉 Authored new claim handling guidelines, procedures, and training to ensure consistency of implementation and execution👉 Mitigated claim costs by eliminating operation inefficiencies✔ Directed Large Loss Reporting for losses exceeding $50K; reviewed all denial letters, reservation of rights letters, and other complex correspondence and documentation for approval

Glen Allen, Virginia, United States

Oversight for 6 benefit coordinators with responsibility for managing workers’ compensation claims for Commonwealth of Virginia employees. Served as liaison to client departments for customer relationship matters; directed and updated services and protocols. ✔ Chartered path to high performance by instituting personalized development plans to address training gaps, motivate employees, and maintain a solid pipeline of talent; led to increased development opportunities and internal promotions for 50% staff✔ Established cross-functional open communication protocols to drive accountability and productivity across business functions; actions resulted in quick retention of new business process, improved customer satisfaction, and heightened employee morale

Richmond, Virginia Area

• Organized 31 member Claim Department handling 4,750 open credit card claims. • Approved / denied high exposure and questionable coverage claims. • Developed performance enhancement program that improved production compliance by 21.16% and increased customer survey scores to two year highs of 96%.• Developed New – Hire training program and Claims Manual via multi-departmental team.

Richmond, Virginia Area

Guided 6 multi-line claim adjusters responsible for $40M incurred, 750 open claims (DC,DE,MD,NC,SC,VA).✔ Settlement / Reserve authority up to $ 250K and accept, disclaim or reserve rights of coverage.✔ Identified and hired new staff and developed training programs. Conducted performance appraisals and established individual goals and objectives to support those in the organization. ✔ Developed and implemented comprehensive quality improvement program leading to internal auditing scores in excess of corporate goals. ✔ Implemented process to ensure compliance with Medicare requirements on WC claim settlements.

Richmond, Virginia Area

Managed 4 multi-line claims consulting staff in charge of 100+ multi-state clients generating $71 M premium and $ 6.7M agency revenue. ✔ Full life-cycle recruitment and management of staff including establishment of individual and unit goals, monitoring and tracking progress to exceed expectations. ✔ Managed claim financial and technical developments that produced up to 18% reduction of claim cost versus premium ratio. ✔ Interpreted policy coverage for specific claims and recommended responses to stakeholders of payments made, denied or rights reserved. ✔ Served on HRH Corporate Task Force to charter a consultative claims management program and develop proprietary national database.

Washington D.C. Metro Area

Directed all aspects of the workers’ compensation claim program for a 10K member workforce, generating 1,000 claims annually with an incurred cost of $ 10M in DC, MD, VA.✔ Identified, hired, trained, coached, and managed staff. Established individual and office goals and monitored progress towards attaining those goals.✔ Evaluated reserve and settlement recommendations from $ 50K with authority up to $ 1M. ✔ Implemented a comprehensive overhaul of the Third Party Claims Administrator program. Wrote the Request for Proposal and evaluated vendor responses for final selection.✔ Developed executive claim summary and detail reports for Operations Management that identified accident severity / frequency trends and corrective action recommendations.

Fairfax County, Virginia, United States

Directed multi – line claims management programs generating annual Crawford revenue of $ 10M.✔ Implemented programs for new and restructured existing accounts for improved efficiency and cost effectiveness. ✔ Produced annual Stewardship team reports that analyzed claims trends and proposed solutions using proprietary Risk Management Information System.