Claims Associate - Workers Compensation

Sedgwick•Raleigh, NC

About The Position

The Claims Associate analyzes reported lower-level workers compensation claims to determine benefits due and ensure ongoing adjudication in accordance with company standards and industry best practices. The role adjusts medical-only and minor lost-time claims under close supervision and supports other claims representatives, examiners, and leads with larger or more complex claims as needed.

Requirements

High school diploma or GED.
At least 1 year of claims management experience or an equivalent combination of education and experience.
Clear and conceptual thinking, sound judgment, troubleshooting, problem-solving, analytical ability, and discretion.
Ability to handle work-related stress, manage multiple priorities simultaneously, and meet deadlines.
Ability to perform computer keyboarding; travel as required.

Nice To Haves

Bachelor's degree from an accredited college or university.
Professional certification applicable to the line of business.

Responsibilities

Adjust medical-only claims and minor lost-time workers compensation claims under close supervision.
Support other claims representatives, examiners, and leads with larger or more complex claims as necessary.
Process workers compensation claims, determining compensability and benefits due.
Monitor reserve accuracy and file necessary documentation with state agencies.
Communicate claim actions and processing updates to claimants, clients, and appropriate medical contacts.
Ensure claim files are properly documented and claims coding is correct.
Process routine payments and prescriptions and prepare status reports for lifetime medical claims and/or defined-period medical claims, as applicable.
Maintain professional client relationships.