Shem Sandoval
Casper,WY
Summary
Detail-oriented healthcare and administrative professional with 15+ years of experience in remote and on-site medical environments. Skilled in insurance claims, prescription processing, enrollment, billing support, data entry, and accurate documentation. Proven ability to maintain compliance with HIPAA and other regulatory standards while navigating multiple systems and managing high-volume workflows.
Overview
12
12
years of professional experience
2000
2000
years of post-secondary education
Work History
Customer Support Advisor (Remote)
Conduent (Apple Client)
Casper, Wyoming
06.2025 - Current
- Delivered high-volume inbound remote phone support for apple customers, enhancing overall customer experience.
- Assisted with technical troubleshooting for Apple devices and services.
- Facilitated Apple ID recovery, Apple Pay issues, account access, device setup, and software concerns, improving customer self-sufficiency.
- Communicated effectively with both internal teams and external customers via phone, email, chat.
- Addressed customer complaints professionally, contributing to increased customer satisfaction and loyalty.
- Resolved order, shipping, return, and financing/loan inquiries.
- Met strict AHT, quality, compliance, and customer satisfaction metrics.
Medicare Customer Service Representative (Remote)
Continuum Solutions (Sold To Everise) (CVS Client)
Casper, Wyoming
01.2019 - 06.2025
- Managed high-volume inbound Medicare calls, ensuring accurate information and timely assistance in a fully remote setting.
- Coordinated with pharmacies to provide prescription status and resolved member issues with prior authorizations and medication fulfillment.
- Processed prescription claims and verified medication coverage.
- Reviewed benefit eligibility, formularies, and cost of medications.
- Managed grievances, appeals, and enrollment documentation.
- Maintained strict HIPAA compliance and accurate data entry.
- Consistently met productivity and quality assurance standards.
Insurance Marketplace Representative (Remote)
Concentrix (Aetna Client)
Casper, Wyoming
01.2014 - 05.2019
- Provided remote phone support for marketplace insurance members.
- Assisted with enrollment, eligibility verification, and plan selection.
- Reviewed medical claims and explained coverage for procedures and services.
- Processed appeals, grievances, and billing inquiries.
- Documented detailed account notes in compliance with federal healthcare regulations.
- Met performance metrics in a high-volume call center environment.
Education
High School Diploma -
Kellywalsh
Casper, WYSkills
- Insurance Claims & Medicare Support
- Prescription & Benefit Verification
- Enrollment & Appeals Documentation
- Medical Billing & Data Entry
- HIPAA Compliance
- Multi-System Navigation & Accuracy
- High-Volume Workflow Management
- Administrative & back-Office support
- Productivity & Quality Metrics
- Technical troubleshooting
- High Incoming Call Volume
- Customer Service
Timeline
Customer Support Advisor (Remote)
Conduent (Apple Client)
06.2025 - Current
Medicare Customer Service Representative (Remote)
Continuum Solutions (Sold To Everise) (CVS Client)
01.2019 - 06.2025
Insurance Marketplace Representative (Remote)
Concentrix (Aetna Client)
01.2014 - 05.2019
High School Diploma -
Kellywalsh