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Medicare Set Aside Jobs (NOW HIRING)

Capitol Bridge, LLC.

$70K/yr

Review and evaluate workers' compensation Medicare set-aside (WCMSA) proposals, including medical records, to determine if the proposal meets Medicare threshold requirements and adequately considers ...

IME RESOURCES LLC

Planner (32429)

Lawrenceville, GA · On-site

$46K - $63K/yr

The Planner works autonomously to develop Medicare Set-Aside Allocations and other reports as needed within their scope of licensing and/or certifications. ESSENTIAL JOB FUNCTIONS * Collects, reviews ...

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Medicare Set Aside information

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$14

$26

$47

How much do medicare set aside jobs pay per hour?

As of Aug 5, 2026, the average hourly pay for medicare set aside in the United States is $26.77, according to ZipRecruiter salary data. Most workers in this role earn between $20.19 and $28.85 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Medicare Set Aside position, and why are they important?

To thrive in a Medicare Set Aside (MSA) role, a deep understanding of Medicare regulations, workers' compensation law, and medical cost projections is essential, often supported by a background in nursing, legal studies, or claims management. Familiarity with industry-standard software for case management, medical record review, and compliance documentation is typically required, along with relevant certifications such as CMS MSA certification or a Registered Nurse (RN) license. Attention to detail, analytical thinking, strong organizational skills, and effective communication are vital soft skills in this field. These skills ensure the accurate allocation of funds, regulatory compliance, and effective collaboration with legal, insurance, and healthcare professionals.

What does a Medicare Set Aside professional do?

Professionals in a Medicare Set Aside role are primarily responsible for evaluating medical records and treatment histories to determine the future medical expenses related to a workers' compensation or liability claim, ensuring compliance with Medicare guidelines. They collaborate closely with attorneys, insurance adjusters, and healthcare providers to gather necessary information and prepare detailed allocation reports. The role also involves submitting proposals to the Centers for Medicare & Medicaid Services (CMS) and following up on approvals, making project management and regulatory expertise essential. This position is ideal for those who enjoy a mix of analytical work, documentation, and cross-functional teamwork.

More about Medicare Set Aside jobs
What cities are hiring for Medicare Set Aside jobs? Cities with the most Medicare Set Aside job openings:
What are the most commonly searched types of Medicare Set Aside jobs? The most popular types of Medicare Set Aside jobs are:
What states have the most Medicare Set Aside jobs? States with the most job openings for Medicare Set Aside jobs include:
What job categories do people searching Medicare Set Aside jobs look for? The top searched job categories for Medicare Set Aside jobs are:
Medicare Set Aside jobs near you
Infographic showing various Medicare Set Aside job openings in the United States as of July 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $55,676 per year, or $26.8 per hour.

** REMOTE ** Determinations Specialist (32573)

IME RESOURCES LLC

Lawrenceville, GA • Remote

$22 - $26/hr

Full-time

Posted 18 days ago

Job description

Are you a Medicare Set-Aside expert who enjoys analyzing complex cases, solving problems, and making a meaningful impact? ExamWorks is seeking a highly skilled Determinations Specialist to join our team and play a critical role in advocating for accurate Medicare Set-Aside (MSA) recommendations and ensuring compliance with CMS guidelines.

In this position, you'll leverage your clinical knowledge, analytical expertise, and critical thinking skills to evaluate CMS determination letters, identify discrepancies, conduct research, and support successful MSA outcomes for our clients. If you're passionate about navigating complex regulatory requirements and collaborating with clients to achieve the best possible results, we'd love to hear from you.

Schedule: Monday-Friday, 8:00 AM-5:00 PM

Required Qualifications

  • Current MSCC (Medicare Set-Aside Certified Consultant) certification
  • Strong knowledge of the WCMSA Reference Guide and CMS Medicare coverage guidelines
  • Exceptional analytical, research, and problem-solving skills
  • Strong written and verbal communication abilities

Medicare Set-aside Certified Consultant (MSCC)
Medicare Set-aside (MSA)
Centers for Medicare & Medicaid Services (CMS)
Workers' Compensation Review Contractor (WCRC)
MSP Compliance
Medicare Secondary Payer (MSP)

What You'll Do

As a Determinations Specialist, you will:

  • Review CMS determination letters and evaluate cases with and without disagreement regarding MSA recommendations.
  • Identify, analyze, and communicate discrepancies between ECS and CMS recommendations.
  • Conduct comprehensive research and gather supporting clinical and regulatory documentation to substantiate ECS MSA recommendations.
  • Assess CMS findings and determine whether a case warrants reconsideration.
  • Partner with clients to explain recommendations, provide supporting rationale, and determine next steps.
  • Utilize your expertise in Medicare coverage policies and the WCMSA Reference Guide to support case evaluations and decision-making.
  • Analyze and defend ECS recommendations, including complex prescription drug allocations.
  • Build compelling, well-documented submissions and supporting materials for presentation to CMS.
  • Maintain accurate and timely documentation within Galileo and other company systems.
  • Ensure compliance with client protocols, departmental procedures, HIPAA requirements, and all applicable regulations.
  • Contribute to a collaborative team environment while supporting additional projects and initiatives as assigned.

Why Join ExamWorks?

At ExamWorks, you'll work alongside industry experts in a highly specialized field where your knowledge and expertise directly influence outcomes for clients. This role offers the opportunity to tackle challenging cases, deepen your regulatory expertise, and contribute to a team dedicated to excellence, accuracy, and continuous improvement.

If you're an experienced MSCC professional looking for a role that values critical thinking, attention to detail, and subject matter expertise, we encourage you to apply today.

QUALIFICATIONS

  • Previous Customer Service experience required. Minimum 12 months production environment experience or related experience preferred.
  • Adequate knowledge of 3rd party/COB (Coordination of Benefits) / insurance verification / medical billing (ICD-9/CPT) experience preferred.
  • Competency in mathematics, business terminology, clerical skills and time management.
  • Must possess complete knowledge of general computers, fax, copier, scanner, and telephone.
  • Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, Adobe and the Internet.
  • Must have a full understanding of HIPAA regulations and compliance.
  • Ability to follow instructions and respond to managements’ directions accurately.
  • Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
  • Must demonstrate strong written and oral 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.
  • Must be able to maintain confidentiality.
  • Must be able to demonstrate and promote a positive team-oriented environment.
  • Must be able to stay focused and concentrate under normal or heavy distractions.
  • Must be able to work well under pressure and/or stressful conditions.
  • Must possess the ability to manage change, delays, or unexpected events appropriately.

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

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