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Resolution Processing Jobs in New Jersey (NOW HIRING)

Imperial PFS

Client Resolution Specialist

Jersey City, NJ · On-site

$58K - $77K/yr

Overview The Client Resolution Specialist is responsible for managing delinquent premium finance ... Process payments and maintain accurate account records * Communication & Correspondence: * Draft ...

Imperial PFS

Client Resolution Specialist

Jersey City, NJ · On-site

$58K - $77K/yr

Overview The Client Resolution Specialist is responsible for managing delinquent premium finance ... Process payments and maintain accurate account records * Communication & Correspondence: * Draft ...

Imperial PFS

Account Resolution Specialist

Jersey City, NJ · On-site

$58K - $77K/yr

Overview The Account Resolution Specialist is responsible for managing delinquent premium finance ... Process payments and maintain accurate account records * Communication & Correspondence: * Draft ...

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All JobsResolution Processing JobsResolution Processing Jobs in New Jersey

Resolution Processing information

What is the difference between Resolution Processing vs Claims Processor?

AspectResolution ProcessingClaims Processor
Required CredentialsHigh school diploma or equivalent; some roles may require insurance or claims processing certificationsHigh school diploma or equivalent; often requires insurance or claims processing certifications
Work EnvironmentOffice settings, call centers, or remote work; primarily administrative and customer serviceOffice or remote; handling insurance claims, data entry, and customer communication
Industry UsageInsurance, healthcare, financeInsurance, healthcare, government agencies
Common Search/ComparisonResolution Processing vs Claims Processor

Resolution Processing and Claims Processors both handle insurance-related tasks, often in similar environments. Resolution Processing typically focuses on resolving claims issues, discrepancies, or appeals, while Claims Processors primarily review and process insurance claims from submission to payout. Both roles require similar credentials and are used across insurance and healthcare industries. Understanding their differences helps job seekers identify the right career path within the claims and resolution field.

What are popular job titles related to Resolution Processing jobs in New Jersey? For Resolution Processing jobs in New Jersey, the most frequently searched job titles are:
What job categories do people searching Resolution Processing jobs in New Jersey look for? The top searched job categories for Resolution Processing jobs in New Jersey are:
What cities in New Jersey are hiring for Resolution Processing jobs? Cities in New Jersey with the most Resolution Processing job openings:
Resolution Processing jobs near you
Infographic showing various Resolution Processing job openings in New Jersey as of June 2026, with employment types broken down into 85% Full Time, and 15% Temporary. Highlights an 100% In-person job distribution.
Discrepancy Resolution, Team Lead

Discrepancy Resolution, Team Lead

Labor First

Mount Laurel, NJ • On-site

$60K - $70K/yr

Full-time

Posted 16 days ago

Job description

Description
LaborFirst is the leader in Care Navigation and advocacy, dedicated to improving outcomes and satisfaction for group plan sponsors and their members. Founded in 2005, we partner with all major national health carriers to serve 450+ clients and over 375,000 Medical and Pharmacy lives across all 50 states. We deliver high-touch solutions that drive value while preserving benefits. RetireeFirst, a LaborFirst solution, provides end-to-end Retiree Benefits Management. In partnership with plan sponsors, brokers, and consultants, we design, implement, manage, and administer Medicare benefits, ensuring a seamless transition and continued support. HealthActive, our solution for self-insured health plans with actives and early retirees, combines one-on-one health advocacy with technology-driven insights to help members successfully navigate their healthcare journey.
Position Summary
The Discrepancy Resolution Team Lead manages the team responsible for identifying, investigating, and resolving complex Medicare enrollment and eligibility discrepancies. This position oversees daily operations related to CMS and carrier enrollment data, ensuring compliance with CMS regulations while delivering timely, accurate resolution of membership issues.
The Team Lead serves as the primary escalation point for complex eligibility cases, partners with internal departments and external carrier organizations, and provides leadership to the Discrepancy Resolution team to drive operational excellence, quality, and member satisfaction.
Essential Duties & Responsibilities
Leadership & Team Management
  • Lead, mentor, coach, and develop the Discrepancy Resolution team to ensure high-quality performance and professional growth.
  • Monitor team productivity, quality, and turnaround times.
  • Conduct regular performance reviews, provide coaching, and identify training opportunities.
  • Establish workflows and best practices to improve operational efficiency and accuracy.
  • Serve as the primary escalation point for complex eligibility and enrollment issues.

Discrepancy Resolution & Operations
  • Oversee detailed audits of CMS and carrier enrollment files, including Transaction Reply Reports (TRRs), to identify and resolve eligibility and membership discrepancies.
  • Ensure timely investigation and resolution of discrepancies involving Medicare Part A, Part B, Medicaid, Dual Eligible status, Low-Income Subsidy (LIS), and Special Enrollment Periods (SEPs).
  • Monitor reconciliation activities to ensure accurate member eligibility and enrollment records across internal systems and carrier platforms.
  • Maintain compliance with CMS regulations, carrier policies, and organizational procedures.

Member & Carrier Support
  • Oversee member outreach regarding disenrollment, reinstatement opportunities, eligibility requirements, and coverage corrections.
  • Ensure team members communicate Medicare regulations, enrollment timelines, and documentation requirements accurately, professionally, and compassionately.
  • Partner with carrier organizations, onboarding teams, account management, and compliance to resolve complex membership issues.
  • Build strong relationships with carrier contacts to facilitate timely issue resolution.

Process Improvement & Reporting
  • Develop and maintain standard operating procedures (SOPs) for discrepancy resolution processes.
  • Monitor operational metrics and prepare reports identifying trends, root causes, and opportunities for process improvement.
  • Recommend system enhancements and workflow improvements to reduce enrollment errors and improve member experience.
  • Participate in cross-functional initiatives supporting enrollment accuracy, compliance, and operational excellence.

Requirements
Qualifications
  • Bachelor's degree or equivalent combination of education and relevant healthcare experience.
  • Ability to get NJ Healthcare License within 90 days of hire (external)
  • 5+ years of Medicare enrollment, eligibility, discrepancy resolution, or healthcare operations experience.
  • 2+ years of leadership or supervisory experience preferred.
  • Strong knowledge of CMS Medicare enrollment regulations, eligibility requirements, and enrollment processes.
  • Experience working with CMS Transaction Reply Reports (TRRs), eligibility files, and carrier enrollment systems.
  • Experience resolving complex Medicare eligibility and enrollment issues.
  • Strong analytical, organizational, and problem-solving skills.
  • Excellent verbal and written communication skills, including experience handling sensitive member conversations.
  • Proficiency with Microsoft Excel, Microsoft Office Suite, and enrollment management systems.

Preferred Qualifications
  • Experience working with Medicare Advantage and Prescription Drug Plans.
  • Knowledge of CMS enrollment systems, MARx, TRRs, and Medicare eligibility processing.
  • Experience with quality assurance, auditing, and operational reporting.
  • Experience leading healthcare operations or enrollment teams.

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