Conduent seeks a Medical Benefit Review Services Associate to evaluate medical claims, verify member eligibility, and ensure compliance with benefit policies for government and commercial clients. In this role, you will review documentation for accuracy, apply medical and regulatory guidelines, and identify discrepancies or potential fraud. You'll collaborate with internal teams and payers, document decisions, and meet performance and quality standards. This position offers exposure to digital platforms, automation tools, and data-driven workflows, with opportunities to grow skills in healthcare operations and client services. Responsibilities Review and evaluate medical claims against plan benefits and policies Verify member eligibility and coverage details using internal systems Apply medical coding and regulatory guidelines to claim determinations Identify discrepancies, potential fraud, and escalation issues Document determinations and maintain accurate electronic records Meet defined productivity, accuracy, and turnaround-time metrics Collaborate with internal teams and client representatives to resolve issues Use digital and automated tools to process and track claims Contribute to continuous improvement of workflows and procedures Protect sensitive health information in compliance with HIPAA Required Skills Medical claims review Health insurance benefits knowledge

ICD/CPT/HCPCS

coding familiarity Regulatory and compliance understanding Data entry and documentation Claims processing systems (e.g., Facets, QNXT) Excel and reporting skills Quality assurance and auditing Analytical and problem-solving Written and verbal communication