Medicare Set-Aside (MSA) Planner (100% Remote)
The Opportunity
Are you a detail-oriented analyst looking for a high-autonomy, work-from-home role? Join our team as a Remote Medicare Set-Aside (MSA) Planner. In this position, you will work independently from your home office to analyze complex medical records, forecast future healthcare needs, and craft critical MSA Allocations. You will act as a trusted expert, collaborating virtually with attorneys, accounts, and internal teams to deliver high-quality, compliant reports.
What You Will Do
- Analyze & Forecast: Review comprehensive health data and medical records to project future medical needs using established medical standards of care.
- Ensure Compliance: Protect client interests by aligning all reports with federal CMS requirements, state mandates, and URAC guidelines.
- Collaborate & Consult: Partner directly with legal teams, accounts, and internal management to communicate findings and provide regulatory insight.
- Drive Quality: Maintain top-tier quality scores by utilizing exceptional critical thinking, problem-solving, and analytical skills.
- Continuous Growth: Participate in virtual orientation, training sessions, and strategic management meetings to stay ahead of industry changes.
What You Bring
- Industry Expertise: Strong knowledge of the disability and workers' compensation industry, with a deep understanding of Medicare rules and regulations.
- Technical Skills: Proficiency with modern digital tools, including Microsoft Office (Word, Outlook, Excel) and web-based research.
- Communication Power: Exceptional English verbal and written skills, with a sharp eye for grammar, punctuation, and style.
- Work Ethic: A proven ability to work independently, prioritize heavy workloads, multitask under pressure, and manage unexpected changes smoothly.
- Professionalism: Absolute commitment to data confidentiality, reliability, and fostering a positive, team-oriented environment.
Education & Experience Requirements
- Required: Minimum of 1 year of direct experience writing Medicare Set-Asides (MSAs).
- Preferred: Associate degree or equivalent professional certification.
- Preferred: 1+ years of experience in workers' compensation or medical case management.
Certificates, Licenses, Registrations
Will recognize any of the following: Active unrestricted Nursing license (including but not limited to RN, NP LVN, LPN). Active unrestricted Adjuster license. Certification in Medicare Set Asides and/or certifications in Life Care Planning or Legal Nurse Consulting.
QUALIFICATIONS
- Knowledge of the disability and workers' compensation industry including rules and regulations and a full understanding of Medicare rules and regulations.
- Must be able to adequately operate a general computer, fax, copier, scanner, and telephone.
- Must have adequate knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
- Ability to demonstrate critical thinking and problem solving skills.
- Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
- Must be able to work independently, prioritize work activities and use time efficiently.
- Ability to concentrate and multitask in a fast paced work environment.
- Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
- Must be able to maintain confidentiality.
- Must be able to demonstrate and promote a positive team -oriented environment.
- Must be able to work well under pressure and/or stressful conditions.
- Must possess the ability to manage change, delays, or unexpected events appropriately.
- Must be able/willing to work on a flexible schedule when needs arise.
- Must possess excellent skills in English usage, grammar, punctuation and style.
ExamWorks, LLC is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans
Skills Required
- At least 1 year of direct experience writing Medicare Set-Asides
- Knowledge of the disability and workers compensation industry
- Understanding of Medicare rules and regulations
- Proficiency with Microsoft Word, Outlook, Excel, and internet-based tools
- Exceptional English verbal and written communication, including grammar, punctuation, and style
- Ability to work independently, prioritize workloads, multitask, and manage changing circumstances
- Ability to maintain confidentiality and work effectively under pressure
- Associate degree or equivalent professional certification
- At least 1 year of workers compensation or medical case management experience
- Active unrestricted nursing license, including RN, NP, LVN, or LPN
- Active unrestricted adjuster license
- Certification in Medicare Set-Asides, Life Care Planning, or Legal Nurse Consulting
What We Do
ExamWorks Compliance Solutions is a leading authority on Medicare compliance and mandatory insurer reporting. The company provides comprehensive, customizable reporting and compliance solutions, including Medicare Set-Asides (MSAs), conditional payment services, and outcome management. Leveraging clinical and legal expertise, it serves property and casualty insurance carriers, law firms, and government agencies to manage complex medical and pharmaceutical claims.
