ROLE SUMMARY

As a Eligibility Senior Representative e , 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 solid 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 inefficienci

📌 Eligibility Senior Representative (Bengaluru)
🏢 Cigna Healthcare
📍 Bengaluru