Medicare Set-Aside (MSA) Analyst


Performs file reviews, prepares future medical cost projections and Medicare Set-aside Allocation reports. Interacts regularly with the Quality Management Team and Referral Team.

Essential Duties and Functions

  • Performs file reviews
  • Researches Medicare coverage issues
  • Communicates frequently and effectively with Quality Management team and Referral Coordinators
  • Reviews resources on internal Analyst portal frequently, including customer handling instructions
  • Documents files thoroughly and accurately 
  • Prepares future medical cost projections and Medicare Set-Aside allocation reports
  • Provides rationale for allocation and identifies mitigation opportunities
  • Reviews auto-MSA function, adding and deleting treatment items as appropriate
  • Proofreads both calculation and summary generated
  • Performs other duties as assigned

Qualifications and Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Required Qualifications

  • 3-5 years of experience with Workers’ Compensation or Liability claims
  • One of the following (multiple areas preferred):
    • Juris Doctorate degree (preferred)
    • Bachelor’s degree in Nursing, Registered Nurse (RN) License with 3-5 years clinical nursing experience and certifications/ licensing as outline below. (preferred)
    • Paralegal certificate
    • 3-5 years of claims management experience 
    • 3-5 years of MSA Analyst experience 
  • Proficiency in MS Office Suite
  • Accurate typing skills
  • Excellent telephone demeanor
  • Ability to work additional hours, or a flexible schedule, based on occasional increased work demands

Certificates or Licenses

  • Registered Nurses: current RN license and current credentials in at least one of the following CDMS, CLNC, CCMC, CRRN, QRP, LNCC, CIC, LHRM, CHCQM, LCP, or CLCP
  • MSCC or ability to obtain MSCC within 90 days of employment
Ready to apply? Email Team Resources.