Claims Associate - Workers Compensation & Med Only | Jurisdiction: NC |Licensing: Required (Remote)

Sedgwick; Clayton (NC); Remote; USD 42,000 - 62,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401K on day one

Career development opportunities

Job summary

Sedgwick is seeking a Claims Associate for Workers' Compensation to analyze reported lower‑level claims and determine benefits due, while ensuring adjudication aligns with company standards and best practices.

You will adjust medical‑only and minor lost‑time claims under supervision, support larger claims teams, and communicate actions with claimants, clients, and medical contacts. Sedgwick offers comprehensive benefits and growth opportunities.

Qualifications

• High School Diploma or GED required.
• Bachelor's degree preferred.
• 1 year of claims management experience or equivalent.

Responsibilities

• Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision.
• Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
• Processes workers compensation claims determining compensability and benefits due; Communicates claim action/processing with claimant, client and appropriate medical contact.
• Ensures claim files are properly documented and claims coding is correct.
• May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.

Skills

Judgment & decision-making

Troubleshooting

Problem solving

Analytical thinking

Discretion

Keyboarding

Travel (required)

Education

High School Diploma or GED

Bachelor's degree preferred

Job description

Fortune Best Workplaces in Financial Services & Insurance

Claims Associate - Workers Compensation

PRIMARY PURPOSE OF THE ROLE

To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.

• Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision.
• Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
• Processes workers compensation claims determining compensability and benefits due; Communicates claim action/processing with claimant, client and appropriate medical contact.
• Ensures claim files are properly documented and claims coding is correct.
• May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.

Education & Licensing: High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Experience: 1 years of claims management experience or equivalent combination of education and experience required.

Flexible work schedule.

Career development and promotional growth opportunities.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

excellent judgment, troubleshooting, problem solving, analysis, and discretion; Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking.

Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.