Susan Marie Penner
Edmonton,AB
Summary
19 years Primary and Preventative Health Services (formerly Alberta Health) experience explaining / defending the Alberta Health Care Insurance Act Excellent verbal and written interpersonal communication skills Ability to manage internal / external stakeholder expectations in a professional, concerned and timely manner 9 years customer service based experience with WCB
Overview
38
38
years of professional experience
Work History
Policy Analyst
Government of Alberta
10.2024 - Current
- Analyzed policy implications and provided recommendations for strategic decision-making.
- Conducted comprehensive research on legislative trends to inform policy development.
- Collaborated with cross-functional teams to align policy goals with organizational objectives.
- Developed and presented reports on policy analysis to stakeholders and senior management.
- Improved policy effectiveness by conducting comprehensive research and analysis on various issues.
- Developed data-driven policy recommendations for better decision-making and resource allocation.
- Built strong relationships with internal departments for effective collaboration within the organization for policymaking purposes.
- Recommended updates to current legislation, regulations and policies.
- Collaborated with stakeholders to gather input and build consensus around policy proposals.
- Conducted impact assessments to evaluate the potential consequences of proposed policies, identifying both intended and unintended effects on target populations.
Provider Relationship and Claims Team Lead
Government of Alberta - Health
04.2021 - 10.2024
- Provided 16 adjudicators with daily leadership
- Monitored workloads to promote efficient and effective use of staff
- Reviewed, researched and provided direction and feedback regarding unprecedented situations to staff and senior leadership
- Interpreted and provided direction and information to internal and external stakeholders (physicians, professional organizations, general public)
- Researched and created work flow efficiencies
- Acted as a subject matter expert to support senior management initiatives
- Led cross-functional teams to enhance operational workflows and improve overall efficiency.
- Mentored junior staff, fostering skill development and ensuring adherence to best practices.
- Implemented process improvements that streamlined project execution and reduced turnaround times.
Acting Manager Claims Management
Government of Alberta
01.2023 - 04.2024
- Oversaw daily operations to ensure efficiency and compliance with company standards.
- Developed and implemented process improvements that enhanced team productivity.
- Mentored staff, fostering professional growth and improving team performance.
- Collaborated with cross-functional teams to align operational strategies with business goals.
- Managed and motivated employees to be productive and engaged in work.
- Led initiatives to enhance customer satisfaction through improved service delivery methods.
- Accomplished multiple tasks within established timeframes.
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Cross-trained existing employees to maximize team agility and performance.
Claims Specialist
Government of Alberta - Health
10.2016 - 04.2021
- Audited Alberta Health / WCB duplicate claims paid to physicians
- Recovered overpayments where physicians were paid by WCB.
- Managed TIPS / Statement of Benefits Paid investigations.
- Audited claims and provided training support to other units.
- Addressed audit issues from a training perspective and collaborated with Team Leads to correct adjudication performance issues.
- Completed various tasks and projects as required to support the Claims Management Unit.
In-Province Claims Adjudicator
Government of Alberta – Health
04.2012 - 10.2016
- Adjudicated all medical and allied health claims whether paid, applied or refused while adhering to the applicable schedule of medical benefits and governing rules while exceeding benchmarks.
- Communicated with stakeholders providing information via facsimile, written communication and telephone.
- Identified/negotiated with practitioners for the recovery of overpayments.
- Processed Statement of Assessment, Statement of Account and Attachment requests.
- Actively participated in development of self and others.
Adjudicator
Workers’ Compensation Board – Alberta
05.2007 - 04.2012
- Determined initial and ongoing entitlement using WCB Policies, Procedures and Guidelines while meeting benchmarks.
- Determined medical aid and non-rate based entitlements to coordinate and authorize medical investigation treatment.
- Communicated and rationalized complex and detailed information regarding all entitlement decisions and other claim management issues to clients, both in writing and verbally.
Training Analyst I
Workers’ Compensation Board – Alberta
01.2002 - 05.2007
- Assessed the training requirements of potential sponsors for new courseware, objectives and content.
- Designed, developed and delivered technical training courses focusing on the needs of the Customer Contact Centre, Customer Records and Investigation Units.
- Utilized adult learning principles and methodologies in training development.
- Supervised trainees in the classroom while also evaluating learner performance.
- Provided individual performance coaching when required.
Customer Contact Representative
Workers’ Compensation Board – Alberta
05.1999 - 01.2002
- Interpreted, explained and defended the policies, procedures and legislation governing the Workers’ Compensation Board while gathering and documenting relevant information necessary in the adjudication of the claim while adhering to the FOIP regulations.
- Educated stakeholders on Workers’ Compensation matters and promoted the benefits of Workers’ Compensation Board products and services while protecting their rights under the Workers’ Compensation Act.
- Maintained employer accounts, addressed basic appeal issues within my level of authority, identified, gathered and processed required data to continually maintain accounts.
- Educated employers in regards to their reporting responsibilities.
Filing Clerk
Workers’ Compensation Board – Alberta
05.1997 - 04.1999
- Completed duties assigned including batching and filing documents
- Liaised with other units inputting data required to identify and register correct claim numbers and processed modifications on existing documents as required.
- Submitted production statistics on a timely basis.
Administrative Support Clerk IV
Government of Alberta - Health
10.1987 - 11.1994
- Explained, interpreted and defended the acts and regulations of the Alberta Health Care Insurance Plan while communicating, both verbally and in writing, information relating to billings, payments and premium rates.
- Created new stakeholder records and issued replacement documents when required.
- Liaised with other units, sections and government offices and programs.
Education
High School Diploma -
Minnedosa Collegiate Institute
Minnedosa, MB06.1984
Skills
- Policy evaluation
- Qualitative analysis
- Policy analysis / compliance
- Policy formulation
- Legislative review
- Critical thinking
- Records management
- Organizing and prioritizing work
- Documentation skills
- Decision-making
- Collaborative relationships
- Medical terminology
- Claims adjustment
Timeline
Policy Analyst
Government of Alberta
10.2024 - Current
Acting Manager Claims Management
Government of Alberta
01.2023 - 04.2024
Provider Relationship and Claims Team Lead
Government of Alberta - Health
04.2021 - 10.2024
Claims Specialist
Government of Alberta - Health
10.2016 - 04.2021
In-Province Claims Adjudicator
Government of Alberta – Health
04.2012 - 10.2016
Adjudicator
Workers’ Compensation Board – Alberta
05.2007 - 04.2012
Training Analyst I
Workers’ Compensation Board – Alberta
01.2002 - 05.2007
Customer Contact Representative
Workers’ Compensation Board – Alberta
05.1999 - 01.2002
Filing Clerk
Workers’ Compensation Board – Alberta
05.1997 - 04.1999
Administrative Support Clerk IV
Government of Alberta - Health
10.1987 - 11.1994
High School Diploma -
Minnedosa Collegiate Institute
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