• Job Description

  Req#: 1002
  Sanderson Firm is a woman-owned company specializing in Medicare Secondary Payer (MSP) compliance services. Our team of legal and clinical professionals brings more than 700 years of combined MSP industry experience, serving insurance carriers, self-insured companies, third-party administrators, and governmental entities across the country.
  
  Recognized as one of the fastest-growing MSP compliance companies, Sanderson Firm was ranked #92 on the 2025 Inc. 5000 list of fastest-growing privately held companies in America. We are proud of our 100% client retention rate and our reputation for delivering innovative solutions that help clients achieve MSP-compliant settlements.
  
  At Sanderson Firm, you'll join a fast-growing, collaborative team where your work makes a meaningful impact on our clients and the industry. We are committed to fostering a supportive environment where employees are valued, ideas are encouraged, and contributions directly help shape the future of our firm. Join us today!
  
  1. POSITION SUMMARY:
  
  The Medicare Set-Aside (MSA) Specialist is responsible for developing future medical allocation reports based on evidence-based medical guidelines and guidance published by the Centers for Medicare & Medicaid Services (CMS). In this role, the specialist will apply clinical expertise and professional judgment to prepare Medical Cost Projections and Medicare Set-Asides for workers' compensation and liability settlements in accordance with established standards of practice.
  
  The ideal candidate has strong analytical skills, clinical knowledge, and experience interpreting medical records to support accurate and compliant MSA allocations. Experience with Evidence-Based Medicare Set-Asides (EBMSAs) is strongly preferred.
  
  
  1. KEY RESPONSIBILITIES:
     • Review and analyze medical records, billing/payment records, and pharmacy histories to identify an injured individual's past, current, and future treatment needs related to an accident or injury.
     • Prepare clear, concise medical record summary narratives outlining findings and recommendations.
     • Apply evidence-based medical treatment guidelines and CMS guidelines when developing future care recommendations.
     • Document and support the rationale for findings and case analysis.
     • Identify and distinguish Medicare-covered and non-Medicare-covered treatment.
     • Assign and incorporate appropriate CPT, HCPCS, and ICD codes based on case specifics.
     • Communicate and collaborate with claims professionals, attorneys, physicians and their representatives, clients, and internal team members.
     • Maintain established company quality standards and documentation requirements.
     • Meet weekly productivity and production goals while ensuring accuracy and compliance.
  1. QUALIFICATIONS & SKILLS:
     • Proficiency in Microsoft Office Suite, including Word and Excel for document preparation and data management.
     • Ability to effectively multitask in a high-volume environment while maintaining accuracy and attention to detail.
     • Excellent written and verbal communication skills with the ability to present information clearly and professionally.
     • Ability to meet designated deadlines in a fast-paced, production-driven environment.
     • Strong interpersonal, organizational, and time management skills.
     • Ability to work independently and collaboratively within a team environment.
     • Demonstrated strong attention to detail and commitment to quality.
  2. EDUCATION / EXPERIENCE (two or more of the following):
     • 5+ years of Medicare Set-Aside (MSA) experience.
     • Graduate of an accredited school of nursing (BSN or LPN) or possession of an active Registered Nurse (RN) license.
     • Professional certification preferred, such as MSACP, MSCC, CMSP, CLCP, or CNLCP.
     • 5+ years of experience in case management, utilization review, or claims management.

• About the company

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