CMS Section 111 Compliance Specialist - WC Claims

Proassurance; Carmel (IN); Hybrid; USD 58,000 - 95,000; Full time

Job summary

ProAssurance is seeking a Compliance Specialist to ensure CMS Section 111 reporting for MMSEA Medicare Secondary Payer Act within its workers' compensation line, Eastern Alliance. The role is hybrid, with office location visits about 2 days per month.

Requires a bachelor’s degree (or equivalent experience), at least 3 years in workers’ comp claims, solid knowledge of medical terminology and CMS rules, and MS Word/Excel proficiency.

Qualifications

• Bachelor’s degree required; HS diploma with 8+ years in medical/legal/insurance can substitute.
• Minimum 3 years of workers’ compensation claims experience.
• Strong knowledge of medical terminology and workers’ compensation processes; CMS reporting preferred.
• Proficiency with Microsoft Word and Excel; ability to learn new software.

Responsibilities

• Perform CMS Section 111 data elements entries for quarterly CMS submissions.
• Maintain ORM and TPOC data, including ICD codes and settlement details.
• Manage ORM termination within jurisdictional statutes and CMS NGHP guidance.
• Coordinate with claim representatives to resolve missing data and document activity.
• Monitor CMS correspondence and Medicare inquiries; direct appropriate payments.
• Attend meetings and support insurance-related projects and professional development.

Skills

Medical terminology

Workers' compensation processes

CMS reporting

Analytical thinking

Attention to detail

Time management

Communication skills

Confidentiality

Education

Bachelor's degree

High School Diploma/GED with 8+ years experience

Tools

Microsoft Word

Microsoft Excel

Job description

ProAssurance is seeking a Compliance Specialist to ensure CMS Section 111 reporting for MMSEA Medicare Secondary Payer Act within its workers' compensation line, Eastern Alliance. The role is hybrid, with office location visits about 2 days per month.

Requires a bachelor’s degree (or equivalent experience), at least 3 years in workers’ comp claims, solid knowledge of medical terminology and CMS rules, and MS Word/Excel proficiency.