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 transparent, 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 escalate recurring errors, pr

📌 Claims Adjustments Senior Representative (Bengaluru)
🏢 The Cigna Group
📍 Bengaluru