Claims Senior Representative

ROLE SUMMARY

As a Claims Senior Representative you will play a critical role in delivering accurate timely and highquality operational processing across your function (e.g. Claims/Adjustments Eligibility Administration Customer Service Support Client Setup and Subrogation).

You will handle highercomplexity 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 problemsolving 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 highercomplexity backoffice tasks in line with SOPs and business rules e.g high cost authorisation.
• Independently handle exceptions unclear scenarios and nonroutine 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 auditready.

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 dataprotection requirements.
• Promote highquality processing through consistent modelling of bestpractice 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 skillbuilding for new hires demonstrating systems and workflows.
• Act as a reliable point of contact for daytoday operational questions.
• Foster a collaborative environment by supporting peers and sharing effective practices.

Cross Team CollaborationTeam 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 highquality reporting.
• Provide input into operational dashboards or summaries when required.

Service & Risk Awareness

• Anticipate downstream impacts of processing decisions and ensure smooth endtoend operations.
• Escalate potential customerimpacting or compliance risks promptly.
• Support a culture of operational discipline accuracy and proactive problemsolving.

YOUR PROFILE

• 46 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.
• Customerfocused mindset with awareness of how backoffice 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.

• ProblemSolving 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