Mike Stoops Email & Phone Number

Oak Ridge, Tn

Manages a team of claim adjusters handling worker’s compensation claims in twenty-five states. Manages staff nurses, vendors, bill review and managed care vendor, PPO provider, PBM, primary care physicians, and defense counsel. Also maintains a personal inventory of high exposure claims.

Chicago

Managed staff of senior members administering company personnel policies, interviewing, hiring, and developing performance objectives. Provided daily performance metrics for internal staff and, through audit and review, ensured the quality of FMLA decisions. • Managed a remote staff of eight badging representatives.• Conducted quarterly badging audits, at the direction of the Customs and Border Patrol, in two locations.• Assisted with the annual TSA-conducted audit of United ID Media Plan. Updated the United ID Media Plan as needed.• Conducted ongoing review of select FMLA transactions, assigning responsibility for errors and managing ongoing process improvement initiatives.

Managed business results and relationships with all vendors used for large-deductible and self-insured workers’ compensation program, including TPA, bill review and managed care vendor, PPO provider, PBM, primary care physicians, and defense counsel. • Managed all aspects of corporate claim review program, providing technical claim oversight and direction to TPA claims administrators countrywide.• Achieved reduction in excess of 30% in claim volume.• Developed and administered claim training initiatives for TPA, focusing on subrogation and litigation management, as well as reserve development.• Produced stewardship reports summarizing effectiveness of vendor partners.• Established and negotiated results-based performance guarantees for TPA, managed care and bill review vendors.• Measured progress against performance targets and negotiated adjustments to performance expectations and money at risk.• Identified risk and developed solutions to control negative trends in claims development.• Monitored changes in law and developed strategies for improving overall performance in response to new and developing legal challenges. Analyzed and summarized claims data.• Generated internal and external presentations and reports addressing frequency, severity, reserve adequacy, and payment trends.• Directed workers’ compensation claim management strategies.• Oversaw RFP process for TPA partners and managed care partners, including development of questions for input, analyzing responses, and making recommendations regarding selection process.• Conducted quarterly status and account review meetings with all major partners, focusing on results of prior quarter and strategy for future handling.