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. This role focuses on CMS Section 111 reporting, ORM and TPOC data management, and ensuring timely, accurate submissions under CMS guidance.

The position is hybrid, with ~2 days/month in an Eastern Alliance office, and requires a strong grasp of medical terminology, state laws, and meticulous data handling to protect claimants and ensure regulatory compliance.

Qualifications

• Bachelor's degree required; equivalent work experience acceptable.
• Minimum three years in workers’ compensation claims.
• Strong knowledge of medical terminology and common procedures.
• Extensive knowledge of workers’ compensation processes and state laws.
• CMS reporting knowledge preferred.
• Proficiency in Microsoft Word and Excel; ability to learn new software.

Responsibilities

• Conduct CMS Section 111 data element inputs into CMS systems with QA checks.
• Manage ORM and TPOC data across jurisdictions and monitor deadlines.
• Coordinate with claim representatives to resolve data gaps and document activity.
• Monitor CMS correspondence and Medicare inquiries; aid in issuing appropriate payments.
• Maintain knowledge of CMS requirements and participate in meetings.
• Support company projects and participate in industry events.

Skills

Attention to detail

Time management

Communication skills

Analytical thinking

Multitasking

Empathic listening

Confidentiality

Organizational skills

Education

Bachelor's degree or equivalent

Tools

Microsoft Office

CMS reporting knowledge

Job description

ProAssurance is seeking a Compliance Specialist to support the Eastern Alliance workers' compensation line. This role focuses on CMS Section 111 reporting, ORM and TPOC data management, and ensuring timely, accurate submissions under CMS guidance.

The position is hybrid, with ~2 days/month in an Eastern Alliance office, and requires a strong grasp of medical terminology, state laws, and meticulous data handling to protect claimants and ensure regulatory compliance.