Claims Associate - Workers Compensation

Sedgwick • Raleigh, NC

5d

About The Position

The Claims Associate analyzes reported lower-level workers compensation claims to determine benefits due and ensure ongoing adjudication within 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. The associate processes claims, determines compensability and benefits, monitors reserve accuracy, files required documentation with state agencies, communicates claim actions, maintains accurate claim files and coding, and builds professional client relationships.

Requirements

• High school diploma or GED required.
• At least 1 year of claims management experience, or an equivalent combination of education and experience, required.

Nice To Haves

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

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 by determining compensability and benefits due.
• Monitor reserve accuracy and file necessary documentation with state agencies.
• Communicate claim actions and processing with claimants, clients, and appropriate medical contacts.
• Ensure claim files are properly documented and claims coding is correct.
• May process routine payments and prescriptions and prepare status reports for lifetime medical claims and/or defined-period medical claims.
• Maintain professional client relationships.

Benefits

• Flexible work schedule.
• Referral incentive program.
• Career development and promotional growth opportunities.
• Medical, dental, and vision benefits available on day one.
• 401(k) available on day one.
• Diverse and comprehensive benefits to support mental, physical, financial, and professional needs.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED