Claims Senior Representative

YOUR RESPONSIBILITIES

Claims Management

Manage end-to-end medical claims processing, ensuring accurate adjudication, timely turnaround, and resolution in line with policy terms and SLA requirements.

Team Training & Mentorship
Provide coaching, training, and ongoing guidance to claims handlers, particularly on complex cases, to drive accuracy, productivity, and overall team performance.

Customer & Stakeholder Engagement
Act as a subject matter expert for clients and internal stakeholders, addressing escalations, providing claim updates, and ensuring a high level of service delivery.

Cross-functional Collaboration
Partner closely with internal teams and other books of business to resolve claims efficiently and improve overall operational effectiveness. **Compliance & **

Governance
Ensure all claims are processed in accordance with regulatory requirements, company policies, and internal quality standards, maintaining high audit and compliance scores.

Process Improvement & Strategy
Identify gaps and drive continuous improvement initiatives in claims processes, workflows, and customer experience.

Additional Responsibilities:

Negotiation & Resolution
Support negotiations with stakeholders to achieve fair and accurate claim outcomes, particularly for complex or high-value cases. Reporting & Analysis
Prepare and analyze claims reports, identify trends, and provide insights to support operational decision-making and performance improvement.

REQUIREMENTS:

• Minimum 3 years of experience in medical claims processing / insurance operations
• Strong understanding of medical claims lifecycle, adjudication, and policy coverage
• High attention to detail with strong accuracy and quality focus
• Good communication and stakeholder management skills
• Experience in training, mentoring, or supporting junior team members is an advantage
• Ability to manage multiple priorities in a fast-paced environment

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.