Sandra Dias
Summary
Detail-oriented claims specialist excelling in claims analysis, negotiation, and customer service. Proven ability to streamline processes and enhance efficiency, consistently achieving high customer satisfaction.
Overview
2027
2027
years of professional experience
Work History
Associate Total Loss Claims Specialist
Amica Mutual Insurance Company
Raynham, MA
06.2025 - Current
- Analyzed complex insurance claims, ensuring compliance with company policies and regulatory guidelines.
- Facilitated claim resolution through effective communication with clients.
- Mentored junior staff on best practices in claims processing and customer service techniques.
- Streamlined workflow processes to enhance efficiency in claims handling procedures.
- Completed training sessions on new systems and tools for improved operational effectiveness.
- Implemented quality control measures to ensure accuracy in claim assessments and settlements.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
- Followed up with customers on unresolved issues.
- Collaborated with cross-functional teams to optimize claims handling procedures, resulting in improved productivity.
- Provided exceptional customer service during stressful situations by offering empathy and support while resolving issues efficiently.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
- Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
- Achieved performance targets consistently through attention to detail, effective time management, and strong decision-making abilities.
- Negotiated settlements with claimants and attorneys, achieving favorable outcomes for all parties involved.
Senior Total Loss Claims Representative
Amica Mutual Insurance Company
Raynham, MA
2023 - 2025
- Processed and evaluated insurance claims, ensuring compliance with company policies and industry regulations.
- Communicated effectively with clients to gather necessary documentation and resolve inquiries regarding claims status.
- Utilized claims management software to track claim progress and maintain accurate records for reporting purposes.
- Assisted in training new team members on claims protocols and best practices to ensure quality service delivery.
- Identified opportunities for process improvements in claims handling procedures, enhancing overall efficiency.
- Provided exceptional customer service by addressing client concerns promptly and professionally throughout the claim lifecycle.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Reduced turnaround time for claim settlements by prioritizing tasks and managing deadlines effectively.
- Trained new Claims Representatives on company policies, procedures, and software systems, improving overall team productivity.
- Provided exceptional customer service, addressing concerns and resolving issues promptly.
- Negotiated settlements with claimants, achieving favorable outcomes for both parties.
- Filled in as a Team Lead for over 7 months while still maintaining a regular workload in addition to handling the highest number of CAT claims for the two major hurricanes in the total loss vertical.
Total Loss Claims Representative
Amica Mutual Insurance Company
Raynham, MA
2021 - 2023
- Processed and evaluated insurance claims to ensure compliance with company policies.
- Communicated directly with clients to gather necessary information for claims assessment.
- Analyzed claim documents to determine validity and appropriate resolution paths.
- Collaborated with internal departments to expedite claims processing and improve service delivery.
- Developed strong relationships with clients, facilitating trust and open communication during the claims process.
- Reduced claim resolution times with thorough documentation and timely follow-up.
- Attended virtual inter-departmental trainings to improve understanding of claims process and its impact on customer satisfaction.
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Reduced turnaround time for claim settlements by prioritizing tasks and managing deadlines effectively.
Claims Service Representative III
Amica Mutual Insurance Company
Raynham, MA
2018 - 2021
- Processed and managed incoming claims, ensuring accuracy and compliance with company policies.
- Assisted clients in understanding coverage options and claim procedures, providing exceptional customer support.
- Collaborated with internal teams to resolve complex claims issues, enhancing overall service efficiency.
- Utilized claims management software to document case details and track progress throughout the claim lifecycle.
- Enhanced customer satisfaction by efficiently processing and resolving claims in a timely manner.
Associate Claims Service Representative
Amica Mutual Insurance Company
Raynham, MA
2016 - 2018
- Processed and assessed insurance claims efficiently, ensuring compliance with company policies and regulations.
- Communicated effectively with clients to gather necessary claim information and provide updates on status.
- Utilized claims management software to document case details and track claim progress accurately.
- Resolved client inquiries promptly, enhancing customer satisfaction and retention rates within service guidelines.
- Identified opportunities for process improvements, contributing to enhanced accuracy in claims resolution.
- Maintained detailed records of claim activities, supporting audits and ensuring data integrity across systems.
- Provided exceptional customer service by addressing concerns, answering questions, and explaining complex policy information to clients.
- Demonstrated strong negotiation skills in settling disputes between insured parties and third-party claimants fairly while protecting company interests.
Education
Psychology And Dance With Minor in Sociology
Dean College
Franklin, MASkills
- Claims
- Claims processing
- Claims investigation
- Verbal communication
- Microsoft office
- Settlement determinations
- Policy interpretation
- Compliance management
- Claims analysis
- Documentation review
- Negotiation leadership
- Settlement coordination
- Settlement management
- Time management
- Decision-making
- Critical thinking
- Customer service
- Organizing and prioritizing work
- Attention to detail
- Teamwork and collaboration
- Multitasking Abilities
- Interpersonal communication
- Problem-solving
- Insurance coverage verification
- Active listening
- Analytical thinking
- Problem-solving abilities
- Excellent communication
- Conflict resolution
Languages
English
Native or Bilingual
Portuguese
Native or Bilingual
Timeline
Associate Total Loss Claims Specialist
Amica Mutual Insurance Company
06.2025 - Current
Senior Total Loss Claims Representative
Amica Mutual Insurance Company
2023 - 2025
Total Loss Claims Representative
Amica Mutual Insurance Company
2021 - 2023
Claims Service Representative III
Amica Mutual Insurance Company
2018 - 2021
Associate Claims Service Representative
Amica Mutual Insurance Company
2016 - 2018
Psychology And Dance With Minor in Sociology
Dean College