Claims Adjustments Senior Representative

Cigna; Bengaluru; On-site; INR 600,000 - 900,000; Full time

Job summary

Cigna is seeking a Claims Adjustment Senior Representative to support clients worldwide by delivering accurate, timely adjustments and claims processing. You will handle standard and high-complexity cases, including failed payments and medical, dental, and vision claims, while acting as a reliable escalation point and guiding colleagues to ensure quality outcomes.

Join a global team at our Bengaluru Global Service Centre, contributing to compliance, data integrity and efficient workflow.

Qualifications

• 1-2+ years of experience in claims, adjustments, payment processing or a comparable back-office operations environment.
• Working knowledge of claims or adjustment workflows, policy terms, benefit plans, SOPs and system navigation.
• Demonstrated ability to manage complex, escalated or exception cases independently and exercise sound judgement within defined authority.
• Excellent attention to detail, numerical accuracy and ability to organise and prioritise multiple workloads against deadlines.
• Good analytical and problem-solving skills, with the ability to investigate issues, identify patterns and support root-cause understanding.
• Strong written and verbal communication skills, with the confidence to work with internal and external stakeholders.

Responsibilities

• Process and adjudicate medical, dental and vision claim adjustments in line with policy terms, benefit plans, SOPs, business rules and defined authority limits.
• Handle failed payments, exceptions, unclear scenarios and non-routine adjustment cases independently, escalating where authority or guidance is required.
• Review, investigate and resolve aged, escalated, priority or high-cost cases, ensuring relevant stakeholders are informed.
• Maintain accurate, complete and audit-ready system updates, calculations, documentation and case notes.
• Monitor turnaround times and complete work within agreed service levels, highlighting risks or delays promptly.
• Collaborate with Claims, Payment, Eligibility, Customer Service, Finance, Quality, Product, Compliance and Technology teams to resolve operational issues.

Job description

Band 2 | Global Service Centre

ROLE SUMMARY

As a Claims Adjustment Senior Representative, you will support clients across the world by delivering accurate, timely and high-quality adjustment and claims processing. Reporting to the Claims Adjustment Supervisor, you will manage standard and higher-complexity adjustments, including failed payments and medical, dental and vision claim activity received from providers, partners, clients and members. You will act as a reliable escalation point, support workflow and quality management, guide colleagues, and help strengthen operational consistency, compliance and customer outcomes.

KEY RESPONSIBILITIES

Claims Adjustment Processing & Complex Case Handling

• Process and adjudicate medical, dental and vision claim adjustments in line with policy terms, benefit plans, SOPs, business rules and defined authority limits.
• Handle failed payments, exceptions, unclear scenarios and non-routine adjustment cases independently, escalating where authority or guidance is required.
• Review, investigate and resolve aged, escalated, priority or high-cost cases, ensuring relevant stakeholders are informed.
• Maintain accurate, complete and audit-ready system updates, calculations, documentation and case notes.
• Monitor turnaround times and complete work within agreed service levels, highlighting risks or delays promptly.

Customer & Stakeholder Support

• Respond within agreed time commitments to enquiries relating to plan design, eligibility, claim or adjustment status, and take the required action to support resolution.
• Work effectively with internal and external customers, providers and partners to investigate issues and achieve clear, accurate outcomes.
• Consider the downstream impact of adjustment decisions and support smooth end-to-end claims and payment processing.

Quality, Accuracy, Risk & Compliance

• Complete peer reviews and quality checks as assigned by the supervisor or team lead.
• Identify and escalation recurring errors, processing risks, potential overpayments, procedural gaps or customer-impacting issues.
• Adhere to regulatory, audit, data-protection and internal control requirements, maintaining confidentiality at all times.
• Model right-first-time processing and consistently meet individual and team productivity and quality standards.

Workflow, Data & Reporting Support

• Support the monitoring of adjustment and claims work queues, prioritising critical, high-cost, aged and service-sensitive cases.
• Review operational data to identify trends, discrepancies, recurring adjustment drivers or potential root causes, and highlight insights to leaders.
• Ensure accurate case categorisation and data entry to support reliable reporting, dashboards and operational summaries.

Process Improvement & Knowledge Sharing

• Interpret SOPs and guidance in complex or ambiguous situations, seeking clarification where required and helping colleagues apply them consistently.
• Provide practical day-to-day support, informal coaching and knowledge transfer to colleagues, including new hires and less-experienced analysts.
• Identify process inefficiencies and recommend improvements that strengthen accuracy, controls, turnaround time and customer experience.
• Contribute to the maintenance of guides, templates, FAQs and checklists used within Claims Adjustment.

Cross-Team & Regional Collaboration

• Collaborate with Claims, Payment, Eligibility, Customer Service, Finance, Quality, Product, Compliance and Technology teams to resolve operational issues.
• Work across European and Middle East operations, and with other regions where required, to support consistent service delivery and knowledge sharing.
• Actively support colleagues and flex across priorities to help achieve team goals and meet business needs.
• Complete other reasonable duties appropriate to the role.

YOUR PROFILE

• 1-2+ years of experience in claims, adjustments, payment processing or a comparable back-office operations environment.
• Working knowledge of claims or adjustment workflows, policy terms, benefit plans, SOPs and system navigation.
• Demonstrated ability to manage complex, escalated or exception cases independently and exercise sound judgement within defined authority.
• Excellent attention to detail, numerical accuracy and ability to organise and prioritise multiple workloads against deadlines.
• Good analytical and problem-solving skills, with the ability to investigate issues, identify patterns and support root-cause understanding.
• Strong written and verbal communication skills, with the confidence to work with internal and external stakeholders.
• Ability to support colleagues through practical guidance, knowledge sharing and constructive feedback.
• Customer-focused, proactive and adaptable, with awareness of how back-office decisions affect service and member outcomes.
• Proficient in Microsoft Office applications and confident learning multiple operational systems.
• Fluent in English; additional lang