Sandra Adame
Farmers Insurance
Santa Clarita,CA
26
years of professional experience
Accomplished Internal Premium Auditor with over 26 years of experience in the insurance industry, specializing in Workers Compensation policy auditing, compliance, and dispute resolution. Achieved 95% penalty prevention through timely policy reviews and maintained 100% client satisfaction. Skilled in supporting managers and cross-functional teams, overseeing high-volume case files, and meeting critical deadlines with precision. Recognized for strong communication, empathy and organizational skills that enhanced insured's care and team efficiency.
Including proficient in Nexus, Nexusaudit, Outlook, and other internal audit/compliance systems.
Work History
Internal Auditor
26 Years 3 Months- Oversaw compliance and audit documentation for workers' compensation, policies, ensuring accuracy and adherence to all states regulations (CA, OR, NY, NJ, AZ, TX, MO, etc)
- Supported high call volume by providing clear and professional communication with insureds, person of records and/or agents. Thus, included building strong relationships by providing clear communication and timely follow-ups.
- Investigated discrepancies discovered during auditing process. In research on WCRIB/NCCI - subcontractor compliance and officer minimums to verify payroll classification codes and resolve discrepancies.
- Policy reviews were completed ahead of deadlines, Keeping the oldest under 80 days old and preventing penalties on 95% of cases and assisted in improving the company's compliance ratio.
- Processed an average of 50+ audits per week, assigned estimated premiums of under $10,000. While serving as backup support for high email dispute and phone cases in with the Dispute team by investigating and resolving disputes and providing 100% client satisfaction rating.
- Trained new team members on audit and dispute procedures and maintained detailed training notes and process documentation to ensure consistency.
Customer Service/Senior Member Services Representative
2 Years 1 Month- Supported the introduction of new products or system changes by adapting quickly and assisting colleagues as needed with the transition period.
- Fostered strong relationships with members, leading to increased loyalty and trust in the organization''s services.
- Delivered friendly, high-volume, front-end support at the Member Service desk, resolving questions, returns/exchanges, and billing issues while following club. policies.
- Educated customers about billing, payment processing and assist with any troubleshooting to keep wait times low and order accurate.
- Operated POS, processed cash/credit/EBD transactions.
Education
High School Diploma
Skills
Policy compliance
Oral and written communications
Fraud investigations
Researching
Experienced with NEXUS
NEXUS AUDIT
NCCI/WCRIB/PAS
Attention to detail/Problem Solving
Advanced mathematics
Documentation and reports (941s
State forms)
EXCEL
Time Management
10 key
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Timeline
Customer Service/Senior Member Services Representative
Sams Club
10.2022 - 11.2024Read More
Internal Auditor
Farmers Insurance
05.1999 - 08.2025Read More
Fillmore High
High School Diploma
Read More