Daniel Montoya
Operations & Escalation Specialist
Lourdes
Summary
Operations and support professional with experience in financial services, fraud support, insurance claims, technical support, and escalations. Skilled in Salesforce and ServiceNow, experienced in handling HIPAA/PCI-regulated data, back-office operations, and complex case resolution in fast-paced environments.
Overview
9
9
years of professional experience
2
2
Languages
Work History
Dental Insurance Claims Specialist
Orthofi - Skycom BPO
03.2021 - Current
Managed sensitive patient and insurance data while adhering to HIPAA and PCI security standards.
Processed and submitted 180+ dental insurance claims weekly, ensuring timely resolution.
Addressed unresolved unpaid, delayed, or denied insurance claims.
Addressed payment discrepancies and claim issues effectively
Ensured accurate tracking and allocation of checks, EFTs, and ERAs to maintain financial compliance.
Directed management of customer cases and documentation through Salesforce CRM.
Escalation Support Specialist
Blackhawk Network
06.2019 - 03.2021
Managed escalated customer and business support cases for prepaid reward rebate and gift card programs, ensuring timely resolution of issues.
Managed supervisor escalation calls and resolved complex issues via phone, chat, email, and ServiceNow CRM
Assisted cardholders with account support, facilitating replacements and balance inquiries to enhance customer satisfaction.
Coordinated with businesses and authorities to address suspected fraud activity, mitigating potential risks.
Coordinated with businesses and authorities regarding suspected fraud activity
Applied PCI compliance procedures while handling sensitive information
Technical Support Representative
DIRECTV - Teleperformance
09.2017 - 09.2018
Offered technical solutions for DirecTV residential and business customers through inbound call interactions.
Troubleshot cable and service-related concerns, enhancing customer satisfaction.
Supported business accounts including bars, restaurants, RV services, and apartment complexes
Coordinated technician service schedules to ensure timely account support.
processed customer payments adhering to PCI compliance standards
Education
Technical Diploma in Accounting -
Bertha Fidelia Cañas National Institute
San Salvador, El Salvador 05.2001 -
Skills
Claims Management Software
Data privacy compliance
Claims Processing, Fraud Support, Escalation Handling, Back-Office and Tech Support Operations
Insurance Claims Review
Microsoft Office (Excel, Word, PowerPoint), Google Workspace (Sheets, Docs, Slides)
Escalation handling and Analytical thinking
Timeline
Dental Insurance Claims Specialist
Orthofi - Skycom BPO
03.2021 - Current
Escalation Support Specialist
Blackhawk Network
06.2019 - 03.2021
Technical Support Representative
DIRECTV - Teleperformance
09.2017 - 09.2018
Technical Diploma in Accounting -
Bertha Fidelia Cañas National Institute
05.2001 -
Technical Skills
Technical Support
Technical troubleshooting and end-user support, providing step-by-step issue resolution
CRM & Case Management Systems
Salesforce CRM, ServiceNow, Ticketing Systems
Compliance & Security
HIPAA Compliance, PCI Compliance, Healthcare data privacy handling, Account Security Procedures
Financial & Fraud Operations, Healthcare Payment Management
Claims Processing, Fraud Support, Escalation Handling, Back-Office Operations
Office & Productivity Tools
Microsoft Office (Excel, Word, PowerPoint), Google Workspace (Sheets, Docs, Slides)
Work References
Orthofi - Skycom BPO
Vanessa Cruz: +503 7642-2766
Blackhawk Network
Katherine Ortiz: +503 7730-4579
DIRECTV - Teleperformance
Jaime Leiva: +503 7553-5813