Claims Senior Representative

ROLE SUMMARY As a Claims Senior Representative , you will play a critical role in delivering accurate, timely, and high‑quality operational processing across your function (e.g., Claims/Adjustments, Eligibility, Administration, Customer Service Support, Client Setup and Subrogation). You will handle higher‑complexity cases, support workflow management, provide guidance to colleagues, and help drive quality, accuracy, and operational consistency. Acting as a reliable escalation point for Band 1 analysts, you contribute directly to operational excellence by applying deeper process knowledge, problem‑solving capability, and proactive risk identification. This role keeps operations running smoothly by ensuring work is completed right the first time, supporting continuous improvement, and helping maintain control, compliance, and strong service outcomes.

KEY RESPONSIBILITIES Operational Processing & Complex Case Handling Complete both standard and higher‑complexity back‑office tasks in line with SOPs and business rules e.g high cost authorisation. Independently handle exceptions, unclear scenarios, and non‑routine cases within defined authority limits. Review, investigate, and resolve aged, escalated, or priority cases. Ensure all system updates, documentation, and case notes are accurate, complete, and audit‑ready.

Quality, Accuracy & Compliance Conduct peer reviews and quality checks as assigned by team leads or supervisors. Identify and flag risk, recurring errors, procedural gaps, or accuracy risks and escalate promptly. Support compliance by maintaining strict adherence to regulatory requirements, audit, and data‑protection requirements. Promote high‑quality processing through consistent modelling of best‑practice standards.

Process Adherence & Continuous Improvement Interpret SOPs in complex or ambiguous situations and support colleagues in understanding them. Provide actionable feedback on recurring issues, process inefficiencies, or unclear guidance. Contribute to process improvement initiatives, working with SMEs or leads to refine workflows. Assist in maintaining and updating reference materials (guides, templates, FAQs, checklists).

Coaching & Knowledge Sharing Provide informal coaching to Band 1 analysts and support knowledge transfer. Assist with onboarding and skill‑building for new hires, demonstrating systems and workflows. Act as a reliable point of contact for day‑to‑day operational questions. Foster a collaborative environment by supporting peers and sharing effective practices.

Cross Team Collaboration‑Team Collaboration Work collaboratively with peers, supervisors, and support teams (IT, Quality, Product, Compliance) when operational issues arise. Escalate cases appropriately and assist with root cause understanding. Collaborate across regions to support consistent delivery and knowledge sharing, including Middle East operations

Workflow, Data & Reporting Support Help monitor workflow queues, ensuring prioritised handling of critical cases. Review operational data for trends, discrepancies, or recurring issues and highlight insights to leaders. Ensure accurate data entry and case categorisation to support high‑quality reporting. Provide input into operational dashboards or summaries when required.

Service & Risk Awareness Anticipate downstream impacts of processing decisions and ensure smooth end‑to‑end operations. Escalate potential customer‑impacting or compliance risks promptly. Support a culture of operational discipline, accuracy, and proactive problem‑solving.

YOUR PROFILE 4–6 years of experience in (claims/adjustments, admin, eligibility, onboarding, customer service support, subrogation  or similar). Strong understanding of operational workflows, SOPs, and system navigation. Demonstrated ability to manage complex or escalated cases independently. High attention to detail with consistent accuracy and reliability. Ability to support and guide colleagues with process knowledge and practical insights. Good analytical skills with the ability to interpret data and identify patterns or issues. Strong written and verbal communication skills. Customer‑focused mindset with awareness of how back‑office work impacts customer experience. Adaptable, proactive, and comfortable navigating change or shifting priorities. Fluent in English; additional languages beneficial.

KEY COMPETENCIES Operational Expertise –  Strong understanding of functional processes and SOPs. Problem‑Solving – Investigates issues, identifies root causes, and proposes solutions. Collaboration & Coaching – Works effectively across teams, support peers and contributes to a strong team culture. Quality Orientation – Focused on accuracy, compliance, and error reduction Customer Focus – Ensures work contributes to positive customer outcomes. Continuous Improvement – Actively looks for ways to streamline or enhance processes. Communication – Clear, structured, and supportive communication with peers and leaders. Time & Priority Management – Manages complex workloads and deadlines efficiently. System Navigation – Confident using multiple operational systems and learning new tools.

About The Cigna Group

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.