Summary
Overview
Work History
Education
Skills
ADDITIONAL EXPERIENCE
Work Availability
Work Preference
Timeline
Carmel Porras

Carmel Porras

Simi Valley,CA

Summary

Experienced with project coordination, ensuring tasks are completed on time and within scope. Utilizes strong planning and organizational skills to manage resources effectively. Track record of enhancing team collaboration and streamlining workflows to drive project success.

Overview

29
29
years of professional experience

Work History

Director of Claims

Sigmatico Management Company LLC
09.2023 - 07.2025
  • Managed claims processing to ensure compliance with regulatory standards and company policies.
  • Led cross-functional teams to streamline operations and improve claims resolution timelines.
  • Conducted regular audits of claims files to ensure adherence to internal controls and best practices.
  • Streamlined communication between adjusters and clients, expediting claim resolution times.
  • Improved claims processing efficiency by implementing streamlined workflow procedures.
  • Conducted thorough investigations of complex claims, gathering evidence to support decision-making processes.
  • Utilized advanced software tools to efficiently manage large caseloads and track progress on individual cases.

Stop Loss Coordinator

EBA&M Corporation
01.2011 - 08.2023
  • Establishing and maintaining all phases of reinsurance filing, including interpreting stop loss contracts and plan documents; meeting filing deadlines and maintaining correspondence and detailed tracking logs.
  • Work closely with internal departments to coordinate processing and filing of stop loss eligible claims.
  • Identify and issue trigger diagnosis and 50% reports. Filing of initial, advance, and subsequent submissions.
  • Create, organize, file, and track highly sensitive cases to obtain reimbursements for clients with strict deadlines. Including multiple variations of filing requirements and accounting transaction reports.
  • Analyze internal processes, recommend, and implement procedural or policy changes to improve operations, including converting to paperless files.
  • Research and gather data to present concise financial reporting for stop loss cases, and annual audits.

Administrative Assistant

EBA&M Corp
05.1996 - 08.2023
  • Office management: machine maintenance, vendor invoices, supply maintenance, recommend locations for new facilities, oversee the renovating and relocation of over 50 employees.
  • Determine staffing requirements; interview, hire, develop and train administrative staff.
  • Day to day management of 3-5 administrative team members; establish and monitor goals / production.
  • Fashioned and automated daily statistics and production reports that provided senior management with a key decision-making tool.
  • Successfully transitioned through 4 major system conversions: specialty applications VBA, GBAS & RIMS.
  • Preparing detailed documents for subpoenas.
  • Managed annual IRS notices, filing requirements, appealed, and prevented penalty fines.

Education

Associate degree for Transfer - Business and Technology

Moorpark College, Moorpark, CA
05.2001
  • Relevant Coursework
  • Certificate in Accounting
  • GPA: 3.8

Skills

  • Conversant with Windows/MS office programs, word processing, spreadsheet applications, QuickBooks and ten key 75 WPM
  • Knowledge of Self-Funded Insurance and Stop Loss Reinsurance
  • Experience with medical and dental benefit designs and interpretations
  • Audit preparation, identify, trace, and correct errors
  • Working knowledge of medical terminology and billing codes
  • Interpret and apply written rules and regulations, including contracts and plan documents
  • Maintaining a variety of files, ledgers, registers, and journals
  • Lead and review the work of support staff
  • Certified as HIPAA Compliant

ADDITIONAL EXPERIENCE

  • PTA Treasurer & Secretary Sumac Elementary School & Lindero Middle School, Agoura, CA / August 2011 - June 2017
  • Maintained permanent records to track unit funds and financial transactions.
  • Chair budget committees and prepared annual budgets
  • Recorded minutes at monthly board meetings.
  • Created new procedures to preserve PTA records to pass on to the incumbent chair.
  • WAGS – Board of Directors Secretary & Director of Concessions Westlake Agoura Girls Softball League , Agoura, CA / November 2015 - June 2019
  • Prepared and distributed accurate records of the proceedings of committee meetings.
  • Responsible for all board correspondence; custodian of the Bylaws and policies of the League.
  • Organized, purchased and directed the activities of the snack shack facilities.

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Work Preference

Work Type

Full Time

Work Location

RemoteHybrid

Important To Me

Company CultureWork from home optionWork-life balancePaid sick leave401k match

Timeline

Director of Claims - Sigmatico Management Company LLC
09.2023 - 07.2025
Stop Loss Coordinator - EBA&M Corporation
01.2011 - 08.2023
Administrative Assistant - EBA&M Corp
05.1996 - 08.2023
Moorpark College - Associate degree for Transfer, Business and Technology

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