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Medicare Set information

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$14

$26

$47

How much do medicare set jobs pay per hour?

As of Jul 5, 2026, the average hourly pay for medicare set 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 is the difference between Medicare Set vs Medicare Claims Processor?

AspectMedicare SetMedicare Claims Processor
Required CredentialsCertification in Medicare policies, often a healthcare or insurance backgroundSimilar certifications, with focus on claims processing and insurance regulations
Work EnvironmentHealthcare facilities, insurance companies, or government agenciesInsurance companies, healthcare providers, or government offices
Employer & Industry UsageUsed in healthcare administration, insurance, and government programsPrimarily in insurance companies and healthcare organizations handling claims

Medicare Set roles focus on managing Medicare enrollment and eligibility, while Medicare Claims Processors handle the submission and processing of claims. Both roles require similar certifications and work within healthcare and insurance environments, but they serve different functions within the Medicare system.

What are the key skills and qualifications needed to thrive as a Medicare Set-Aside (MSA) Specialist, and why are they important?

To thrive as a Medicare Set-Aside (MSA) Specialist, you need a thorough understanding of Medicare regulations, workers’ compensation, and medical cost projection, often supported by a background in healthcare, case management, or legal fields. Familiarity with MSA software platforms, legal documentation systems, and certification such as Certified Medicare Set-Aside Consultant (MSCC) is highly beneficial. Strong analytical thinking, attention to detail, and effective communication are critical soft skills for coordinating with clients, attorneys, and medical providers. These skills and qualifications ensure compliance, accurate MSA allocations, and protection of Medicare’s interests in settlement cases.

What are some common challenges faced by professionals working in Medicare Set-Aside (MSA) roles?

Professionals in Medicare Set-Aside roles often encounter the challenge of staying current with frequently changing CMS guidelines and regulations. Accurately assessing future medical costs for injured individuals and ensuring compliance with federal requirements demands strong attention to detail and analytical skills. Additionally, collaborating with attorneys, claims adjusters, and medical providers can be complex, as it requires clear communication and negotiation to balance the interests of all parties while protecting Medicare's interests. Navigating these challenges successfully is essential to providing effective and compliant MSA services.

What are Medicare Set-Asides (MSAs)?

Medicare Set-Asides (MSAs) are financial arrangements used to allocate a portion of a settlement from a workers’ compensation or personal injury claim to cover future medical expenses that would otherwise be paid by Medicare. The purpose of an MSA is to ensure that Medicare does not pay for medical costs that should be covered by the settlement. MSAs are reviewed and approved by the Centers for Medicare & Medicaid Services (CMS) to ensure compliance with federal law. Properly establishing an MSA helps protect the beneficiary’s eligibility for Medicare and prevents legal complications.
More about Medicare Set jobs
What job categories do people searching Medicare Set jobs look for? The top searched job categories for Medicare Set jobs are:
Medicare Set jobs near you
Infographic showing various Medicare Set job openings in the United States as of June 2026, with employment types broken down into 73% Full Time, 20% Part Time, and 7% Temporary. Highlights an 100% In-person job distribution, with an average salary of $55,676 per year, or $26.8 per hour.

Senior Workers Compensation Claim Representative - Diamond Bar CA

MSCCN

Diamond Bar, CA • On-site

$70K - $116K/yr

Full-time

Posted 19 days ago

Job description


ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps.
Salary Range
$70,400.00 - $116,200.00
Target Openings
1
What Is the Opportunity?
This role is eligible for a sign-on bonus.
This position is eligible for a hybrid schedule. Employees may work up to 2 day per week at their primary residence. This position will office out of the Diamond Bar or Irvine location.
Under general supervision, manage Workers' Compensation claims with lost time to conclusion and negotiate settlements where appropriate to resolve claims. Coordinate medical and indemnity position of the claim with a Medical Case Manager. Independently handles assigned claims of low to moderate complexity where Wage loss and the expectation is a return to work to modified or full duty or obtain MMI with no RTW. There are no litigated issues or minor to moderate litigated issues. The claim may involve minor sprains/ minor to moderate surgery. The Injured worker is working modified duty and receiving ongoing medical treatment. The injured worker has returned to work, reached Maximum Medical Improvement (MMI) and is receiving PPD benefits. File will close as soon as the PPD is paid out. Independently handles all assigned claims up to and including most complex where Injured worker (IW) remains out of work and unlikely to return to position. Employer is unable to accommodate the restrictions. The claim involves moderate to complex litigation issues IW has returned to work, reached Maximum Medical Improvement (MMI), and has PPD. File litigated to dispute the permanency rating and/or causality. IW has been released to work with permanent restrictions and job is no longer available. IW is receiving Vocational Rehabilitation. Claims that have been reopened for additional medical treatment on more complex files. Injuries may involve one or multiple back, shoulder or knee surgeries, knee replacements, claims involving moderate to complex offsets, permanent restrictions and/or fatalities. Claims on which a settlement should be considered.
What Will You Do?
Conduct investigations, including, but not limited to assessing policy coverage, contacting insureds, injured workers, medical providers, and other parties in a timely manner to determine compensability.
Establish and update reserves to reflect claim exposure and document rationale. Identify and set actuarial reserves. Apply knowledge to determine causal relatedness of medical conditions.
Manage files with an emphasis on file quality (including timely contact and proper documentation and proactive resolution of outstanding issues). Achieve a positive end result by returning injured party to work and coordinating the appropriate medical treatment in collaboration with internal nurse resources where appropriate.
Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome. Work in collaboration with specialty resources (i.e. medical and legal) to proactively pursue claim resolution opportunities, (i.e. return to work, structured settlement, and discontinuation of benefits through litigation).
Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome
Collaborate with our internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services into the overall claim strategy.
Prepare necessary letters and state filings within statutory limits. Pursue all offset opportunities, including apportionment, contribution and subrogation.
Evaluate claims for potential fraud. Proactively manage inventory with documented plans of action to ensure timely and appropriate file closing or reassignment.
Proactively manage moderate to complex litigation to drive files to an optimal outcome, including resolution of benefits. Understand and apply Medicare Set Asides and allocations.
Negotiate settlement of claims within designated authority. May use structured settlement/annuity as appropriate for the jurisdiction. Apply deep technical expertise to assist in the resolution of highly complex claims. Mentor other Claim Professionals
Participate in Telephonic and/or onsite File Reviews. Respond to inquiries - verbal and written. Keep injured worker apprised of claim status
Act as technical resource to others.
Participate in Telephonic and/or onsite File Reviews. Respond to inquiries - verbal and written. Keep injured worker apprised of claim status. Act as technical resource to others. Engage specialty resources as needed.
Performs other assigned duties which may include: Applies deep technical/subject matter expertise to assist in the resolution of complex claims. Acts as an independent mentor to other Claim Professionals. May be dedicated to and apply skills necessary to manage special account relationships (sensitive or complex). May primarily manage a specialized inventory of Workers' Compensation claims.
Acts as an independent mentor to other Claim Professionals Applies deep technical/subject matter expertise to assist in the resolution of complex claims
Acts as an independent mentor to other Claim Professionals
In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
Maintain Continuing Education requirements as required.
Perform other duties as assigned.
Additional Qualifications/Responsibilities
What Will Our Ideal Candidate Have?
Bachelor's Degree.
General knowledge of estimating system Xactimate.
Customer Service experience -.
Interpersonal and customer service skills - Advanced.
Organizational and time management skills- Advanced.
Ability to work independently - Intermediate.
Judgment, analytical and decision making skills - Intermediate.
Negotiation skills - Intermediate.
Written, verbal and interpersonal communication skills including the ability to convey and receive information effectively -Intermediate.
Investigative skills - Intermediate.
Ability to analyze and determine coverage - Intermediate.
Analyze, and evaluate damages -Intermediate.
Resolve claims within settlement authority - Intermediate.
Valid passport.
What is a Must Have?
High School Diploma or GED.
One year previous outside property claim handling experience or successful completion of Travelers Outside Claim Representative training program.
Valid driver's license.

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