Workers Compensation Claims Associate | Medical Only Claims | Claims experience preferred | Medical background

Sedgwick•Dublin, OH

9d•Hybrid

About The Position

The Workers Compensation 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 claims and minor lost-time claims under close supervision, while supporting other claims representatives, examiners, and leads with larger or more complex claims as needed. The associate processes claims by determining compensability and benefits due, monitoring reserve accuracy, filing required documentation with state agencies, and communicating claim actions with claimants, clients, and appropriate medical contacts. The role also maintains accurate claim files and coding, may process routine payments and prescriptions and status reports for lifetime or defined-period medical claims, and maintains professional client relationships. The position is based in Dublin, Ohio, with a hybrid schedule for employees within commuting distance of the office and remote work for those outside commuting distance. Sedgwick describes a caring, collaborative, and inclusive culture, with career development and promotional growth opportunities.

Requirements

High school diploma or GED.
Licenses as required.
One year of general office experience or an equivalent combination of education and experience.
Medical terminology background.
Ability to think clearly and conceptually and demonstrate judgment, troubleshooting, problem-solving, analysis, and discretion.
Ability to handle work-related stress, manage multiple priorities simultaneously, and meet deadlines.
Computer keyboarding ability.
Hearing, vision, and talking abilities.

Nice To Haves

Claims industry experience is preferred.
Claims experience is preferred.

Responsibilities

Adjust medical-only workers compensation claims and minor lost-time claims under close supervision.
Support other claims representatives, examiners, and leads with larger or more complex claims as needed.
Process workers compensation claims, 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.
Process routine payments and prescriptions and status reports for lifetime medical claims and/or defined-period medical claims, as applicable.
Maintain professional client relationships.