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 in the nation, Sanderson Firm was ranked #667 on the 2026 Inc. 5000 list of America’s fastest-growing privately held companies, following our #92 ranking in 2025. This continued recognition reflects our significant growth and commitment to innovation within the MSP industry. 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 and be part of what’s next at Sanderson Firm!
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.
KEY RESPONSIBILITIES
- Reviews and analyzes medical records, billing and payment documentation, and pharmacy histories to identify an injured individual’s past, current, and future treatment needs related to an accident or injury.
- Prepares clear and concise medical record summary narratives that outline findings and recommendations.
- Applies evidence-based medical treatment guidelines, including CMS guidelines, when developing future care recommendations.
- Documents and supports the rationale for findings and overall case analysis.
- Identifies and differentiates between Medicare-covered and non-Medicare-covered treatments.
- Assigns and incorporates appropriate CPT, HCPCS, and ICD codes based on case specifics.
- Communicates and collaborates with claims professionals, attorneys, physicians and their representatives, clients, and internal team members.
- Maintains company quality standards and adheres to documentation requirements.
- Meets weekly productivity goals while ensuring accuracy and regulatory compliance.
QUALIFICATIONS & SKILLS
- Proficient in Microsoft Office Suite, including Word and Excel, for document preparation and data management.
- Effectively multitasks in a high-volume environment while maintaining accuracy and attention to detail.
- Demonstrates excellent written and verbal communication skills, with the capability to present information clearly and professionally.
- Meets designated deadlines in a fast-paced, production-driven environment.
- Brings strong interpersonal, organizational, and time management skills.
- Works both independently and collaboratively within a team environment.
- Maintains a high level of attention to detail and a strong commitment to quality.
EDUCATION / EXPERIENCE
- Minimum of five (5) years of experience in Medicare Set-Aside (MSA) preparation and review.
- Graduate of an accredited school of nursing (BSN or LPN), or active Registered Nurse (RN) license required.
- Professional certification preferred, including MSACP, MSCC, CMSP, CLCP, or CNLCP.
- Minimum of five (5) years of experience in case management, utilization review, or claims management.
WHAT WE OFFER YOU
We believe in supporting our team both professionally and personally. Our benefits include:
- 100% Employer-Paid Medical Insurance for employees
- Dental & Vision Coverage
- 401(k) with Company Match
- Company-Paid Life Insurance
- Optional Short Term Disability, Accident Insurance and more
- Paid Time Off & Holidays
- Supportive and team-oriented culture