Updated: July 23, 2024 - The Case Specialist maintains productive relationships with colleagues and effectively communicates in all interactions, fostering a respectful work environment. Engages actively in internal and external business meetings, collaborates on feedback, and identifies developmental opportunities through monthly one-on-one sessions. Delivers exceptional customer service, manages sensitive financial hardship cases, and ensures compliance with legal standards in documentation and dispute resolution.


Tips for Case Specialist Skills and Responsibilities on a Resume
1. Case Specialist, Allstate Insurance, Chicago, IL
Job Summary:
- Direct and execute retail sales calls with the dealership sales team
- Create and manage customer conquest lists to focus salesmen for the dealers on current end use customer opportunities.
- Develop and train dealer sales force in product performance and application, focusing on new products.
- Review and analyze competitive products and pricing details and provide details to field sales team.
- Provide product demonstrations, working applications, identify product limitations, and non-traditional product usage.
- Support region sales and market share objectives
- Act as technical resource to dealer sales professionals and Territory Sales Managers (TSMs) on Case Construction equipment.
- Serve as liaison between marketing, product management and field sales team.
- Adhere to all published organizational, safety policies and procedures as described in the JAS Forwarding employee handbook.
Skills on Resume:
- Retail Sales Execution (Hard Skills)
- Customer List Management (Hard Skills)
- Sales Force Training (Hard Skills)
- Competitive Analysis (Hard Skills)
- Product Demonstration (Hard Skills)
- Sales Support (Soft Skills)
- Technical Resource Provision (Hard Skills)
- Interdepartmental Liaison (Soft Skills)
2. Case Specialist, Liberty Mutual, Boston, MA
Job Summary:
- Maintain positive working relationships with peers, showing respect and communicating openly.
- Work with internal/external stakeholders and participate in business meetings
- Engage in the monthly one-on-one process by openly discussing feedback and identifying opportunities for development
- Providing excellent customer service through all communication channels available to customers.
- Discussing complex and sensitive matters with customers experiencing financial hardship.
- Completing hardship assessments and providing quality solutions over the phone.
- Ensuring all customer contact information and the hardship process complies with legal and regulatory requirements
- Providing quality resolutions to complex problems, or disputes raised by customers
- Ensuring all customer contract information and the complaints management process complies with legal and regulatory requirements.
Skills on Resume:
- Relationship Building (Soft Skills)
- Stakeholder Engagement (Soft Skills)
- Development Feedback (Soft Skills)
- Customer Service Excellence (Hard Skills)
- Financial Hardship Handling (Hard Skills)
- Regulatory Compliance (Hard Skills)
- Dispute Resolution (Hard Skills)
- Data Accuracy Maintenance (Hard Skills)
3. Case Specialist, Humana Inc., Louisville, KY
Job Summary:
- Daily point of contact for JAS queries, issues, and cases
- Assess and validate new cases for insurance claims support and initiate investigations
- Check preliminary notices have been issued by origin and destination offices and ascertain the correct subsidiary
- Log and handle each case for internal reporting as well as with insurance claims handlers
- Summarize new cases for internal reporting on quarterly log, maintain and keep current all case files and correspondence
- Document investigations, validations, and liability exposure for each case
- Administer self-insured cargo claims separately from claims logged through insurance according to established procedures
- Process and follow up on insurance claims, settlements, and subrogation cases
- Work with attorneys and insurance companies including legal actions and recoveries
- Compile monthly and ad hoc data for status reporting under supervision
Skills on Resume:
- Case Management (Hard Skills)
- Claims Processing (Hard Skills)
- Data Logging (Hard Skills)
- Legal Coordination (Hard Skills)
- Internal Reporting (Hard Skills)
- Communication Skills (Soft Skills)
- Problem Solving (Soft Skills)
- Detail Orientation (Soft Skills)
4. Case Specialist, UnitedHealth Group, Minneapolis, MN
Job Summary:
- Manage a team of several hundred Qualified Caregivers
- Select, match and staff the best Qualified Caregivers for clients
- Coordinate schedules with Qualified Caregivers and clients
- Questions, and concerns, ensuring all issues are resolved.
- Gather and input Qualified Caregiver time and attendance data in scheduling software
- Provide assistance in other processes or procedures as requested by the head of function
- Thoroughly analyse complex customer inquiries and own the investigation process from start to finish
- Contact for Legal, Compliance, Complaints, and Customer Service Departments
- Provide customers with best-in-class services
- Manage and own projects which aim to streamline processes and oversee the implementation of improvements
Skills on Resume:
- Team Leadership (Soft Skills)
- Conflict Resolution (Soft Skills)
- Project Management (Hard Skills)
- Staffing Expertise (Hard Skills)
- Data Management (Hard Skills)
- Analytical Solving (Hard Skills)
- Interdepartmental Coordination (Soft Skills)
- Customer Service (Soft Skills)
5. Case Support Specialist, Blue Cross Blue Shield, Dallas, TX
Job Summary:
- Complete up to 15 assessments per day of cases impacted by COVID to determine and address unmet resource needs
- Provide referrals to community-based organizations and state programs
- Maintain up to date and accurate knowledge of resource landscape
- Utilize organizational and time management skills to effectively work in a fast paced and changing work environment
- Foster positive relationships with internal and external partners and stakeholders
- Apply active listening and crisis intervention techniques to cases of distress
- Build and maintain trust with individuals in quarantine and isolation.
- Assess the level -and- urgency of need and appropriate support for all cases.
- Fill out other applications as needed and make referrals on the case's behalf.
- Verify, maintain, and update data in technology platform.
- Provide case with information for local, State & Federal resources/programs
- Assist with immediate and long-term needs
- Provide education and guidance to people put in quarantine and isolation.
- Attend internal and external team meetings.
- Stay up to date on guidance and resources.
Skills on Resume:
- Rapid Assessments (Hard Skills)
- Resource Knowledge (Hard Skills)
- Organizational Skills (Soft Skills)
- Time Management (Soft Skills)
- Relationship Building (Soft Skills)
- Crisis Intervention (Soft Skills)
- Data Verification (Hard Skills)
- Educational Guidance (Hard Skills)
6. Disability Case Specialist, Aetna, Hartford, CT
Job Summary:
- Ensure accurate and timely reporting to the provincial workers compensation board.
- Determine the relationship between the mechanism of injury, the diagnosis and the relationship to entitlement by gathering and analyzing relevant information.
- Handle confidential and sensitive information, documentation, and files in a professional and appropriate manner by privacy and employment legislation.
- Responsible for managing occupational injury and/or illness claims to resolution
- Implementing, developing, and maintaining outcome-focused case management plans
- Support recovery and safe and timely return to work.
- Responsible for creating and updating RTW Plans, preparing written correspondence
- Requesting medical and functional information from health care providers and Workers Compensation Boards.
- Recommend and coordinate appropriate assessments and evaluations, including Job Demands Analyses, Functional Capacity Evaluations, and Independent Medical Examinations.
- Utilize proactive methods to address any barriers throughout the return-to-work process, including early intervention methods when claim progress or recovery stalls.
Skills on Resume:
- Injury Analysis (Hard Skills)
- Confidentiality Management (Hard Skills)
- Case Management (Hard Skills)
- Recovery Support (Soft Skills)
- Plan Development (Hard Skills)
- Medical Coordination (Hard Skills)
- Assessment Coordination (Hard Skills)
- Proactive Intervention (Soft Skills)
7. Disability Case Specialist, Anthem Inc., Indianapolis, IN
Job Summary:
- Advise managers on best practices for all work-related injuries/illnesses while meeting legislative and contractual requirements.
- Communicate effectively with a variety of stakeholders including managers, employees, unions, health care professionals, and the provincial Worker’s Compensation Board
- Support early and safe return to work and/or accommodations in the workplace.
- Collaborate with managers to develop, implement, and monitor return to work plans based on functional information supplied by heath care providers and/or the Worker’s Compensation Board(s)
- Focusing on reducing claim duration and encouraging timely recovery.
- Analyse claims, incidents, and investigation data to illustrate trends and prepare reports.
- Work collaboratively with Health & Safety/Quality & Risk teams
- Identify trends and assist with the development of prevention strategies
- Maintain accurate documentation, records, and sequence of events throughout the life of the claim.
Skills on Resume:
- Legislative Compliance (Hard Skills)
- Stakeholder Communication (Soft Skills)
- Return to Work Support (Soft Skills)
- Plan Implementation (Hard Skills)
- Claims Analysis (Hard Skills)
- Trend Identification (Hard Skills)
- Documentation Maintenance (Hard Skills)
- Team Collaboration (Soft Skills)
8. Disability Case Specialist, Cigna Health, Phoenix, AZ
Job Summary:
- Prepare claim appeals including performing file reviews and drafting formal employer submissions to support reduction in costs
- Represent Disability Management at related grievance meetings and arbitrations as the subject-matter expert.
- Participate in education and training specific to current relevant federal and provincial health and safety legislation, standards, and guidelines
- Responsible for managing medical LOAs/LTD and return to work process for all medical-related non-occupational leaves.
- Manage non-occupational medical leaves of absence and long-term disability claims for a large workforce with varying benefit programs and eligibility requirements across multiple provinces.
- Support the period leading up to LTD benefit eligibility for those of the workforce who are eligible, and proactively manages the transition from LOA (EI) to LTD.
- Claim submission, maintaining up to date medical documentation, return to work, and medical accommodations.
- Arranges assessments such as functional capacity evaluations (FCE) and Independent Medical Evaluations (IME) when appropriate to facilitate successful return to work.
- Provide reports, statistics,technical guidance and expertise on occupational claims management trends for stakeholders and/or committees.
Skills on Resume:
- Claim Appeals Preparation (Hard Skills)
- Grievance Representation (Hard Skills)
- Legislative Education (Hard Skills)
- Medical Leave Management (Hard Skills)
- Benefits Administration (Hard Skills)
- Transition Management (Hard Skills)
- Assessment Coordination (Hard Skills)
- Reporting and Analysis (Hard Skills)
9. Trust and Safety Case Specialist, Kaiser Permanente, Oakland, CA
Job Summary:
- Analyse and investigate complicated customer complaints
- Ensure that each case has been investigated thoroughly and diligently and that a correct solution is given, in accordance with policies and procedures and in respect of all legal requirements.
- Manage player cases escalated by CS where the player is not satisfied with initial solution.
- Manage All player escalations that come back to Customer Service after having been raised to other departments (such as RPF or Traders).
- Review customer complaints and propose to the Trust and Safety Team Manager allowable good will gestures.
- Review and solve customer claims in a timely manner.
- Consistently communicates status with all appropriate parties involved with the customer case.
- Call customers whenever needed in relation to complaint, for follow-up, to diffuse things and communicate the solution.
- Interact with the customers for SOW, DOC and KYC purposes, via all channels of communication: email, live chat, phone, message, et
- Maintain an excellent understanding and knowledge of products on the French market, including the specific functions of poker and sports betting as well as the tools used for each product.
- Being up to date with promotions, competitions and special offers that promote to customers.
- Reporting of sensitive and high-risk cases to the Trust and Safety Team Manager, the Head of Customer Service Operations and the Customer Service Director.
- Requesting assistance with requests that one is not able to solve him/herself and escalating
- Assisting the Risk & Fraud and Finance Departments with fraud checks and processes
- Working rotating shifts or specified hours, as needed by the business.
Skills on Resume:
- Complaint Analysis (Hard Skills)
- Escalation Management (Hard Skills)
- Policy Compliance (Hard Skills)
- Customer Communication (Soft Skills)
- Goodwill Decision Making (Hard Skills)
- Product Expertise (Hard Skills)
- Fraud Detection Assistance (Hard Skills)
- Shift Flexibility (Soft Skills)
10. Application Case Specialist, Centene Corporation, St. Louis, MO
Job Summary:
- Review new business applications for accuracy and timeliness (case mgmt.)
- Collaborate with distribution partners to obtain missing application information
- Complete all reissues on active policies for effective date changes, plan corrections, and DOB information
- Monitor shared email box for reissue requests and complete additional applications for data entry
- Partner with vendors to complete telephone interviews and RX checks for Underwriting review
- Review and correct error reports and unassigned lists for additional applications
- Review and track the unassigned lists for additional applications that are to be data entered
- Collaborate with Underwriting with additional information for application reissues
- Ensure all information is gathered and application is complete for final decision
- Partner with Call Support reps to answer agent inquiries.
- Perform quality assurance on new applications and policy file feeds for issuance and accuracy
- Resolving problems and handling client's issues in a professional and confidential manner
Skills on Resume:
- Application Accuracy Review (Hard Skills)
- Partner Collaboration (Soft Skills)
- Policy Reissuing (Hard Skills)
- Email Management (Hard Skills)
- Vendor Coordination (Hard Skills)
- Error Correction (Hard Skills)
- Quality Assurance (Hard Skills)
- Client Issue Resolution (Soft Skills)