Shield Customer Service Specialist

General Purpose

The Shield Customer Service Specialist position is an administrative customer service role reporting directly to the Manager of the Shield program.  The Shield CSS position requires the ability to communicate effectively with medical providers, customers, and members of group health plans via email, facsimile, and telephone.  Additionally, this position tracks and documents inquiries and email/fax correspondence and routinely follows up on all outstanding claim/bill files.

Duties & Responsibilities

  • Work with customers and medical providers, checking the status of medical bills and responding to specific medical bills and healthcare-related questions.
  • Review client requirements for each Shield eligible claim(s)/bill(s) and complete necessary follow-up.
  • Answer incoming customer calls regarding billing issues, product problems, service questions and general client concerns.
  • Interpret policies and procedures and exercise effective communication.
  • Work with the Bill Review leadership team to stay updated on product knowledge and be informed of any client-related workflow changes and company policies.
  • Provide internal team and client with detailed call log on cases and client inquiries.
  • Document medical provider and client related inquiries in the bill review system and ShareFile.
  • Maintain and triage Medical Provider Inquiry email boxes and other duties as required.


  • High School diploma required; some college preferred.
  • 2+ years of experience in customer service or healthcare-related fields.
  • Knowledge of medical terminology, CPT Codes and DRG billing codes preferred.
  • Strong organizational, oral, written, and interpersonal skills, including courteous telephone etiquette.
  • High comfort level with computers and computer programs (MS Word, MS Excel, MS Outlook).
  • Ability to set priorities and work independently as well as in a team environment.
  • Ability to meet deadlines in a time sensitive environment.
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