Hybrid CMS Compliance Specialist - WC Claims

ProAssurance; Charlotte (NC); Hybrid; USD 58,000 - 95,000; Full time

Job summary

ProAssurance, based in Charlotte, NC, seeks a Compliance Specialist to support the Eastern Alliance workers’ compensation program. The role focuses on CMS data handling, ORM/TPOC management, and regulatory reporting to ensure timely accuracy.

The ideal candidate has a bachelor’s degree or equivalent, at least three years in workers’ compensation claims, and strong CMS knowledge, medical terminology, and MS Office proficiency. Hybrid work with some travel may apply.

Qualifications

• Bachelor’s degree or equivalent with 8 years in medical/legal/insurance environment as allowed.
• Minimum 3 years of experience in workers’ compensation claims.
• Strong knowledge of CMS reporting requirements and state laws.
• Proficiency with MS Office (Word/Excel) and ability to learn new software.

Responsibilities

• Input Section 111 data elements into WCXP for CMS quarterly submissions and ORM/TPOC details.
• Maintain ORM data and termination diaries across jurisdictions within applicable statutes.
• Coordinate and resolve missing data with claim representatives; document activities.
• Monitor CMS correspondence and Medicare beneficiary inquiries as directed by management.
• Attend meetings and participate in company projects and professional development.

Skills

CMS data management

Data analysis

Attention to detail

Communication skills

Time management

Medical terminology

Workers’ compensation knowledge

Education

Bachelor’s degree

Tools

Microsoft Office

CMS reporting

Job description

ProAssurance, based in Charlotte, NC, seeks a Compliance Specialist to support the Eastern Alliance workers’ compensation program. The role focuses on CMS data handling, ORM/TPOC management, and regulatory reporting to ensure timely accuracy.

The ideal candidate has a bachelor’s degree or equivalent, at least three years in workers’ compensation claims, and strong CMS knowledge, medical terminology, and MS Office proficiency. Hybrid work with some travel may apply.