The high-efficiency sedimentation tank has a wide range of application prospects in industrial wastewater treatment due to its small footprint, strong resistance to shock loads, and high efficiency. However, the complex flow field distribution inside significantly affects the treatment performance of the high-efficiency tank. In this study, a three-dimensional geometric model of the high-efficiency sedimentation tank was constructed based on an engineering prototype. The corresponding solid–liquid two-phase, whole-process computational fluid dynamics (CFD) model for the high-efficiency sedimentation tank was established using the realizable k-ε turbulent model and the multiple reference frame (MRF) method. The internal structures of the flocculation zone, plug-flow zone, and clarification zone were optimized, and then the influence of operational process conditions on the flocculation treatment performance was investigated. The results indicate that, for the given engineering model, the average turbulent kinetic energy k in the flocculation zone exhibits a trend that initially increases and then decreases with the increase in the diameter and height of the draft tube. The optimal hydraulic conditions for the flocculation zone are achieved when the diameter of the draft tube is 2.5 m and the height is 3.5 m. The average turbulent kinetic energy dissipation rate in the plug-flow/clarification zone tends to decrease first and then increase as the height of the water tunnel and water-retaining weir increases. The optimal hydraulic conditions for the plug-flow and clarification zones are achieved when the height of the water tunnel is 1.0 m and the height of the water-retaining weir is 1.6 m. Under optimal operating conditions (dosage of dense media particles: 40 mg/L, stirring rate: 30 rpm, and inlet velocity: 0.72 m/s), satisfactory overall hydraulic conditions can be achieved throughout the entire high-efficiency sedimentation tank. Comparisons between a high-efficiency settling tank and a conventional clarifier for the treatment of circulating water sewage in a practical implementation reveals that the ballasted high-efficiency settling tank has advantages in terms of high hydraulic loading, high removal efficiency of hardness, small footprint, and low doses of flocculant. This research will provide reference values for the design and operation optimization of high-efficiency sedimentation tanks.