Erica Domzalski

• Primary responsibility for managing Strategic and CORE Health systems across multiple lines of business and building strong relationships with nationally contracted providers across the country.
• Spearhead initiatives to streamline provider relations processes, identifying key areas for enhancement and guiding decision-makers towards transformative changes.
• Analyze contracts, optimizing fee schedules and reimbursement rates.
• Develop strategic solutions for provider relations challenges, leveraging industry trends and best practices to drive continuous improvement and adaptation.
• Deliver impactful insights to executive leadership, translating complex contractual information into actionable recommendations for organizational growth.

• Establishing and fostering strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings
• Review new policies, products and issue resolution in Chicago, Illinois Market
• Work on end-to-end provider complex claim issues and deliver resolution
• Educate providers and staff on using United Healthcare portal and provide updates on future service enhancements
• Directing and implementing strategies relating to development and management of provider network
• Identifying gaps in network
• Active participation with PCOR reporting relating to HEDIS measurements
• Established building and maintain professional relationships with providers to ensure provider satisfaction
• Prioritize and organizes own work to meet deadlines
• Plan, organize and facilitate WebEx, orientations, and site visits
• Initiated physician and hospital orientations to support ongoing education of health care provider community
• Proactively decreased provider A/R

• Supports and drives process improvement to enhance accuracy outcomes to benefit customer and organization
• Takes necessary actions to prevent call-backs or extended hold times
• Provides specific call detail for ongoing analysis to identify claim accuracy, customer communication and account-level trends that will be shared across departments
• Influences advocates to use resources and experience to identify information necessary to resolve customer issues and build their knowledge and skills
• Creates positive environment in which Advocates are empowered to ask for additional training and coaching
• Researched and resolved disputes, billing discrepancies and claims efficiently to maintain customer satisfaction, boosting NPS scores
• Established and tracked quality department goals and objectives
• Applied coaching techniques and tools to support new hires in improving performance
• Scheduled and chaired quality review meetings to review effectiveness of performance mitigating risk, improving throughput and achieving customer satisfaction
• Assured consistent quality of production by implementing and enforcing automated practice systems
• Evaluated interactions between associates and customers to assess personnel performance and implement strategies for customer satisfaction improvement
• Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity
• Managed 15 new hires to identify quality or call issue trends and create and implement action plans to appropriately address

• Provide subject matter expertise to new hires to increase efficiencies, navigate systems, and identify trends
• Support complex office initiatives
• Strive to exceed goals and objectives
• Establish and maintain effective business relationship
• Keep commitments to customers
• Selected to participate in Cigna pilot program that involved new software to increase self-efficiencies and accuracy via phone with providers and customers
• Analyzed customers' issues and complaints and initiated corrective actions
• Targeted specific community groups with wellness and disease management information
• Managed over 60 calls per day interacted with members and providers