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Resolution Associate Jobs in Woodbury, NJ (NOW HIRING)

Patriot Home Care

EVV Associate

Philadelphia, PA

Exception Resolution & Visit Integrity Research and resolve routine EVV exceptions, including ... Associate's or Bachelor's degree in Healthcare Administration, Business, Information Systems, or a ...

Patriot Home Care

EVV Associate

Philadelphia, PA · On-site

Exception Resolution & Visit Integrity • Research and resolve routine EVV exceptions, including ... • Associate's or Bachelor's degree in Healthcare Administration, Business, Information Systems ...

CareRing Health, LLC

EVV Associate

Philadelphia, PA · On-site

Exception Resolution & Visit Integrity • Research and resolve routine EVV exceptions, including ... • Associate's or Bachelor's degree in Healthcare Administration, Business, Information Systems ...

CareRing Health, LLC

EVV Associate

Philadelphia, PA

Exception Resolution & Visit Integrity Research and resolve routine EVV exceptions, including ... Associate's or Bachelor's degree in Healthcare Administration, Business, Information Systems, or a ...

CareRing Health, LLC

EVV Associate

Philadelphia, PA

$14.75 - $20.25/hr

Exception Resolution & Visit Integrity Research and resolve routine EVV exceptions, including ... Associate's or Bachelor's degree in Healthcare Administration, Business, Information Systems, or a ...

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Resolution Associate information

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How much do resolution associate jobs pay per hour?

As of Aug 31, 2026, the average hourly pay for resolution associate in Woodbury, NJ is $17.04, according to ZipRecruiter salary data. Most workers in this role earn between $15.53 and $18.12 per hour, depending on experience, location, and employer.

What is a resolution associate?

Resolution Associates are professionals responsible for handling and resolving customer complaints, disputes, or issues within an organization. They act as intermediaries between customers and the company, ensuring that concerns are addressed quickly and fairly. Their duties often include investigating problems, communicating solutions, and documenting outcomes to improve customer satisfaction. Resolution Associates typically work in customer service, finance, or operations departments and require strong problem-solving and communication skills.

What are the key skills and qualifications needed to thrive as a resolution associate?

To thrive as a Resolution Associate, you need strong analytical skills, attention to detail, and experience in customer service or issue resolution, often supported by a relevant bachelor's degree. Familiarity with CRM systems, ticketing platforms, and proficiency in office software like Microsoft Excel are typically required. Excellent communication, problem-solving abilities, and patience are vital soft skills for building trust and efficiently resolving client concerns. These competencies are essential for ensuring customer satisfaction, maintaining brand reputation, and streamlining the resolution process.

What are some common challenges faced by resolution associates, and how can they effectively manage them?

Resolution Associates often deal with high volumes of customer inquiries and complex issues that require careful investigation and empathy. One common challenge is balancing the need for quick resolutions with maintaining accuracy and customer satisfaction. Effective time management, strong communication skills, and the ability to adapt to rapidly changing scenarios are essential. Building a solid understanding of company policies and collaborating closely with other departments can help Resolution Associates find solutions efficiently and reduce stress.

How do I start a career as a resolution associate?

To start a career as a resolution associate, you typically need a high school diploma or equivalent, strong communication and problem-solving skills, and experience in customer service or dispute resolution. Entry-level roles often require familiarity with case management software and the ability to handle sensitive information. Gaining relevant certifications or training in conflict resolution can improve job prospects.

What cities near Woodbury, NJ are hiring for Resolution Associate jobs?

Cities near Woodbury, NJ with the most Resolution Associate job openings:

Resolution Associate jobs near you

Appeals & Grievance Case Resolution Specialist

Philadelphia, PA • On-site

AmeriHealth Caritas Health Plan
Health Care and Social Assistance • 5 - 10K employees

8.3

Company rating: 8.3 out of 10

Based on 73 frontline employees who took The Breakroom Quiz

133rd of 315 rated insurance

Great coworkers

Good employer

Paid breaks

Learn more about AmeriHealth Caritas Health Planexternal

Full-time

Medical, Retirement, PTO

Posted 18 days ago

Job description

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.
Your career starts now. We're looking for the next generation of health care leaders.
At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com.
Job Summary
The Appeals & Grievance Case Resolution Specialist is responsible for the full life cycle of assigned member and/or provider appeals and grievance cases. Working under general supervision, this role conducts case intake, investigation, and documentation to ensure accurate and timely resolution consistent with federal state, and accreditation standards. The Specialist serves as a key liaison between members, providers, and internal departments to resolve issues effectively, ensuring the integrity of the appeals and grievance process and compliance with CMS, NCQA, URAC, and state regulatory requirements.
Essential Functions
Case Management
  • Research and analyze case documentation, including benefit coverage, prior authorizations, claims, and regulatory guidance.
  • Communicate with members, providers, or representative to clarify appeal intent and gather missing documentation including incoming calls, outgoing calls, and phone queue work as assigned.
  • Prepare complete and compliant case files, ensuring all required documentation is included.
  • Track case progress and maintain compliance with turnaround times and documentation standards.
  • Generate accurate and timely determination and acknowledgement letters.

Investigation and Resolution
  • Collaborate with internal departments such as Claims, Medical Management, Legal, and Compliance to obtain necessary information for resolution.
  • Identify potential compliance issues or risk factors requiring escalation.
  • Participate in case discussions, internal committee reviews, or external fair hearing preparation as assigned.
  • Document all activities, correspondence, and outcomes in the case management system with attention to detail and accuracy.

Compliance & Quality
  • Ensure case handling meets all application federal and state regulatory requirements, including with CMS, NCQA, and URAC.
  • Maintain confidentiality and protect member information in compliance with HIPPA regulations.
  • Identify opportunities for process improvements to enhance quality and efficiency.

Team Collaboration
  • Serve as a resource to peers and administrators for routine case-related questions.
  • Maintain professional communication with members, providers, and internal stakeholders.
  • Participate in team meetings and contribute to continuous improvement initiatives.

Education/Experience
  • Associate's Degree: in Health Administration, Business, or related field preferred
  • High School Diploma/GES Required

Preferred Experience Level:
  • Knowledge of medical terminology, benefit interpretation, and regulatory processes preferred. Prior experience working with CMS, Medicaid, or state-regulated appeals processes preferred.
  • 2 to 3 years experience in healthcare operations, managed care, or grievance/appeals coordination.

Other Skills
  • Proficiency in Microsoft Office Suite (Word, Excel, Outlook, etc.).
  • Strong attention to detail and organization.
  • Excellent written and verbal communication.
  • Ability to manage multiple priorities in a fast-paced environment.
  • Strong analytical and problem-solving abilities.
  • Customer service orientation with professional communication etiquette.

Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

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