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.