WC Compliance Specialist - CMS Section 111

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 correspondence handling.

This hybrid position reports to an Eastern Alliance office location about 2 days per month. Qualified candidates will have a bachelor's degree (or HS diploma with 8+ years in medical/legal/insurance), at least 3 years in workers' compensation, and strong MS Office skills.

Qualifications

• Bachelor's degree required; HS diploma with 8+ years in medical/legal/insurance can replace.
• Minimum 3 years' workers' compensation claims experience.
• Strong medical terminology and procedures knowledge.
• CMS reporting knowledge preferred.

Responsibilities

• Input Section 111 data elements into CMS/WCXP for quarterly CMS submissions.
• Maintain ORM termination diary and ensure timely ORM/TPOC reporting.
• Resolve missing data with claim representatives and document activity.
• Monitor CMS correspondence and Medicare beneficiary inquiries; direct appropriate payments.
• Maintain current CMS Section 111 requirements knowledge.
• Attend business unit, department, and company meetings.
• Support projects and participate in insurance-related events.

Skills

CMS reporting

Data analysis

Attention to detail

Communication

Time management

Education

Bachelor's degree

High School Diploma with 8+ years experience

Tools

WCXP

Microsoft Excel

Microsoft Word

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 correspondence handling.

This hybrid position reports to an Eastern Alliance office location about 2 days per month. Qualified candidates will have a bachelor's degree (or HS diploma with 8+ years in medical/legal/insurance), at least 3 years in workers' compensation, and strong MS Office skills.