Susan Janzen
Consultant
Susan Janzen is a Health Plan Services Consultant at BluePeak Advisors, a division of Gallagher Benefits Services, Inc. She has been in the healthcare industry for over 25 years and is experienced in managed care, government programs with an emphasis on Organizational Determinations, Appeals and Grievances (ODAG) and indemnity health insurance.
Prior to joining BluePeak Susan held various leadership roles in claims compliance and claims operational areas. She performed compliance activities including Medicare Part C Organizational Determination, Appeals, Grievances (ODAG) reporting, data universe integrity, claim audit oversight and monitoring, and corrective action plan remediation. She’s managed teams responsible for external claim audits for both CMS and commercial health plans, policy and procedural documentation reviews and end-to-end claims processing and procedures. Previously, Susan was employed at a national Managed Care Organization as a Delegation Oversight Manager responsible for the oversight of 40+ delegated downstream claim vendors. She completed both onsite and virtual audits at least annually for each vendor to determine compliance with CMS and health plan guidelines and was responsible for reporting her findings and recommendations to senior management.
At BluePeak Susan serves as a subject matter expert (SME) specializing in Medical and Dental Claim audits.