JOB DESCRIPTION
POSITION : Claims Senior Representative
REPORTING TO : Claims Supervisor
1. JOB PURPOSE
The job holder is responsible of serving providers and insurance companies by determining
requirements, answering inquiries, resolving problems, fulfilling requests and maintaining
database. He/She is responsible for processing as per terms of advantages. He/She should provide
accurate and relevant medical coverage details and maintain pre-approvals and claims processing
as per the defined terms and policies of the organization.
2. RESPONSIBILITIES AND DUTIES
• Follow Claim Manual and SOP strictly, adjudicate claims according to benefit policies, and
meet both financial/procedure accuracy and TAT target on claims adjudication.
• Adjust error claims according to actual situation.
• Monitor and highlight high-cost claims and ensure relevant parties are aware.
• Well handle recoupment and reconciliation work, communicate with providers and
members via call and email for collection and explanation.
• Processes claims from members and providers.




• Assists queries from providers and payers via phone calls or e-mails.
• Maintains files for authorizations and other reports.
• Assesses and processes claims in line with the policy coverage and medical necessity.
• Be fully versed with medical insurance policies for various groups / beneficiaries.
• May assist in training colleagues and asked to share knowledge.
• Accurately assesses eligibility within the policy boundaries.
• Monitors and maintains the claims processing as per the defined terms and policy of the
organization.
• Achieves required processing targets assigned by the team leader on daily, weekly and
monthly basis.
• Monitors the qualitative and quantitative measures for claims & pre-approvals.
• Ensures compliance to any changes in terms of system parameters or process.
• Maintains quality as per framework for accuracy.
• Maintains productivity and responsiveness to the work allocated.
• Collaborate with other st

📌 Claims Senior Representative-IOH (Bengaluru)
🏢 Cigna Healthcare
📍 Bengaluru