CMS Compliance Specialist — Section 111 (WC Claims)

ProAssurance; Lancaster (Lancaster County); Hybrid; USD 58,000 - 95,000; Full time

Job summary

ProAssurance is seeking a Compliance Specialist to support the Eastern Alliance workers’ compensation line. The role focuses on CMS Section 111 reporting, ORM/TPOC data management, and CMS inquiries, with hybrid work 2 days per month across Eastern Alliance locations.

Ideal candidates have a bachelor’s degree or eight years of relevant experience in medical, legal, or insurance settings, plus three years in workers’ compensation claims. Proficiency in MS Office is expected.

Qualifications

• Bachelor’s degree is required; an HS Diploma with 8+ years in medical/legal/insurance can replace the degree.
• Strong knowledge of CMS reporting preferred.
• Excellent organization and time management; attention to detail.

Responsibilities

• Enter Section 111 data elements into CMS WCXP/Compliance fields for quarterly CMS submission.
• Manage ORM termination within jurisdiction statute of limitations and track ORM/ORM termination timelines.
• Coordinate and resolve missing data with claim representatives and document activity in claims notes.
• Monitor CMS correspondence and Medicare beneficiary inquiries, and direct the issuance of payments as appropriate.

Skills

MS Office

Data accuracy

Effective communication

Education

Bachelor’s degree required

HS Diploma + 8+ years experience (alternative)

Tools

Microsoft Office

Job description

ProAssurance is seeking a Compliance Specialist to support the Eastern Alliance workers’ compensation line. The role focuses on CMS Section 111 reporting, ORM/TPOC data management, and CMS inquiries, with hybrid work 2 days per month across Eastern Alliance locations.

Ideal candidates have a bachelor’s degree or eight years of relevant experience in medical, legal, or insurance settings, plus three years in workers’ compensation claims. Proficiency in MS Office is expected.