Claims Associate – Workers Compensation

Sedgwick

. Analyze reported lower-level workers compensation claims to determine benefits due .

Posted 10/19/2026full-timeRemote • North Carolina • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in processing and adjudicating workers compensation claims, ensuring compliance with industry standards and effective communication with stakeholders. Capable of managing multiple priorities while maintaining accurate documentation and professional client relationships.

Highest-signal resume keywords

Claims Management ExperienceWorkers Compensation Claims ProcessingProfessional CertificationClear And Conceptual ThinkingExcellent Judgment And Problem Solving

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationClaims CodingCompensability DeterminationReserve Accuracy MonitoringDocumentation FilingMedical Claims ProcessingKeyboarding Skills

Soft Skills

Clear And Conceptual ThinkingExcellent JudgmentTroubleshootingProblem SolvingAbility To Handle Work-Related Stress

Certifications & Qualifications

Professional Certification

Industry Keywords

Workers CompensationClaims ProcessingClient RelationshipsState Agency DocumentationMedical Contacts

About the role

Key responsibilities & impact

Analyze reported lower-level workers compensation claims to determine benefits due
Ensure ongoing adjudication of claims within company standards and industry best practices
Adjust medical-only claims and minor lost-time workers compensation claims under close supervision
Support claims representatives, examiners, and leads with larger or more complex claims
Process workers compensation claims, determine compensability and benefits due, monitor reserve accuracy, and file necessary documentation with state agency
Communicate claim action and processing with claimants, clients, and appropriate medical contacts
Ensure claim files are properly documented and claims coding is correct
Process routine payments, prescriptions, and status reports for lifetime medical claims and/or defined period medical claims
Maintain professional client relationships

Requirements

What you’ll need

High School Diploma or GED required
Bachelor's degree from an accredited college or university preferred
Professional certification as applicable to line of business preferred
1 year of claims management experience or equivalent combination of education and experience required
Clear and conceptual thinking ability
Excellent judgment, troubleshooting, problem solving, analysis, and discretion
Ability to handle work-related stress
Ability to handle multiple priorities simultaneously
Ability to meet deadlines
Computer keyboarding
Travel as required
Hearing, vision, and talking

Benefits

Comp & perks

Flexible work schedule
Referral incentive program
Career development and promotional growth opportunities
Diverse and comprehensive benefits including medical, dental, vision, and 401K on day one
Reasonable accommodations considered when applicable and appropriate