Medicare Set-Aside Specialist

BCM Law, P.C.; United States; Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Hybrid/remote flexibility

Collaborative team environment

Comprehensive benefits

Job summary

BCM Law, P.C. is seeking an experienced Medicare Set-Aside Specialist to join our growing Medicare Compliance Practice Group. This role focuses on preparing WCMSA allocations through medical record review, future cost projections, and MSP principles.

The ideal candidate will have strong Medicare Secondary Payer knowledge, experience analyzing complex medical records, and a track record of producing defensible work product in collaboration with our Medicare Compliance team nationwide.

Qualifications

• 3–5 years of WCMSA allocation experience.
• Strong knowledge of the Medicare Secondary Payer Act, CMS WCMSA Reference Guide.
• Experience reviewing complex medical records, treatment histories, and data.
• Experience projecting future medical costs for workers' compensation claims.
• Clinical background (RN, LPN, NP, PA, or other healthcare experience) preferred.
• MSCC or CMSP certification preferred.
• Strong analytical, organizational and problem-solving skills with attention to detail.
• Excellent written and verbal communication skills and the ability to work with attorneys.

Responsibilities

• Review medical records and documentation to evaluate future injury-related medical needs.
• Prepare accurate WCMSA allocations per CMS guidance and accepted methodologies.
• Project future medical and prescription costs related to work injuries.
• Evaluate case-specific facts to protect Medicare's interests during settlement.
• Prepare amended allocations and updates as circumstances evolve.
• Collaborate with the Medicare Compliance team to support settlement strategy.
• Stay current on CMS guidance and industry best practices.

Skills

Medicare compliance

WCMSA allocations

Medical record review

Communication, written

Analytical skills

Education

Healthcare background

Tools

CMSP certification

MSCC certification

Job description

Hybrid/Remote Role

BCM Law, P.C. is seeking an experienced Medicare Set-Aside Specialist to join our collaborative and growing Medicare Compliance Practice Group. This role is responsible for preparing accurate, well-supported Workers' Compensation Medicare Set-Aside (WCMSA) allocations through comprehensive medical record review, future medical cost projections, and application of Medicare Secondary Payer (MSP) principles.

The ideal candidate has a strong understanding of Medicare Secondary Payer compliance, enjoys analyzing complex medical records, and takes pride in producing high-quality, defensible work product. Working closely with the firm's Medicare Compliance team, this individual will play an integral role in helping clients navigate Medicare compliance during the settlement process.

Founded in 1997, BCM Law, P.C. has built a reputation as trusted advocates and advisers for employers and insurers facing complex legal challenges. Our team brings deep experience across Workers’ Compensation Defense, Civil Litigation Defense, Insurance Law, and Medicare Compliance. Our Medicare Compliance Practice Group works directly alongside our defense attorneys to evaluate exposure, address Medicare’s interests, and develop defensible settlement strategies nationwide.

Qualifications

• Minimum of 3-5 years of experience preparing Workers' Compensation Medicare Set-Aside (WCMSA) allocations.
• Strong knowledge of the Medicare Secondary Payer Act, CMS WCMSA Reference Guide, and accepted MSA allocation methodologies.
• Demonstrated experience reviewing and interpreting complex medical records, treatment histories, pharmacy records, and payment data.
• Experience projecting future medical and prescription drug costs related to workers' compensation claims.
• Experience preparing amended reviews, re-reviews, and allocation revisions.
• Clinical background (RN, LPN, NP, PA, or other healthcare experience) strongly preferred.
• MSCC, CMSP, or other Medicare compliance certification preferred.
• Strong analytical, organizational, and problem-solving skills with exceptional attention to detail.
• Excellent written and verbal communication skills and the ability to work collaboratively with attorneys and the Medicare Compliance team.

Responsibilities

• Review and analyze medical records, treatment histories, pharmacy records, and claim documentation to evaluate future injury-related medical needs.
• Prepare accurate and defensible Workers' Compensation Medicare Set-Aside (WCMSA) allocations in accordance with CMS guidance and accepted industry methodologies.
• Project future medical and prescription drug expenses related to work injuries using sound clinical judgment and evidence-based allocation practices.
• Evaluate case-specific facts to determine appropriate methods of protecting Medicare's interests during settlement.
• Prepare amended allocations, re-reviews, and allocation updates as medical treatment or claim circumstances evolve.
• Collaborate with the firm's Medicare Compliance team to support settlement strategy and Medicare compliance.
• Assist with allocation revisions and provide technical support throughout the CMS review process, as needed.
• Stay current on CMS guidance, industry best practices, and Medicare Secondary Payer developments to ensure accurate and defensible work product.

Why BCM Law, P.C.?

At BCM Law, P.C., we hire with the expectation that you will build your career here. Our Medicare Compliance team is fully integrated within our workers' compensation defense practice, providing the opportunity to work directly with experienced attorneys on complex cases rather than in a traditional high-volume vendor environment.

We are intentional about creating an environment where experienced professionals can thrive, contribute, and continue growing.

We offer:

• Competitive compensation and comprehensive benefits
• Hybrid/remote flexibility with a collaborative and supportive team environment
• Meaningful, hands-on work supporting complex cases nationwide
• Opportunities to continue developing expertise in Medicare compliance and industry best practices
• Consistent communication, feedback, and leadership support

If you are looking for a firm where your contributions matter, your expertise is respected, and you can grow within a stable and collaborative environment, we would welcome the opportunity to connect.