Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day. **Job Track Description:** + Requires formal education and relevant expertise in a professional, sales, or technical area. + Performs technical-based activities. + Contributes to and manages projects. + Uses deductive reasoning to solve problems and make recommendations. + Interfaces with and influences key stakeholders. + Leverages previous knowledge and expertise to achieve results. + Ability to complete work self-guided. + College or university degree required. **General Profile** + Requires knowledge and experience in the field. + Will acquire higher-level knowledge and skills. + Develops an understanding of the company, processes, and customers. + Uses existing procedures to solve routine or standard problems. + Receives moderate guidance and direction from others. **Functional Knowledge** + Requires expanded conceptual understanding of theories, practices, and procedures. **Business Expertise** + Uses an understanding of key business drivers to accomplish work. **Impact** + Impacts a team, by example, through the quality service and information provided + Works within guidelines and policies. **Leadership** + No supervisory responsibilities. + Provides informal guidance to new team members. **Problem Solving** + Uses existing procedures to solve standard problems. + Examines information and standard practices to make judgments. **Interpersonal Skills** + Exchanges complex information and ideas effectively. **Responsibility Statements** + Applies medical judgment to adjudication of cases/claims. + Reviews requests for denial reconsideration and appeals. + Manually price and review claims for appropriateness of care or coverage. + Works directly with the client to provide input under program policy or procedural requirements. + Coordinate with clinical peer reviewers for case/claim resolution. + Performs other duties as assigned. + Complies with all policies and standards. **Additional Information** + Requires Registered Nurse license in good standing. Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form (https://downloads.conduent.com/content/usa/en/file/conduent-applicant-adaaa-referral-form.pdf) . You may also click here to access Conduent's ADAAA Accommodation Policy (http://downloads.conduent.com/content/usa/en/document/cdt\_adaaa\_accommodation\_pol.pdf) . _At Conduent we value the health and safety of our associates, their families and our community. For US applicants while we DO NOT require vaccination for most of our jobs, we DO require that you provide us with your vaccination status, where legally permissible. Providing this information is a requirement of your employment at Conduent._