Clinova Health · AI Claims Automation Specialist
AI Claims Review Associate
8 weeks · 12 hrs/week · Remote · Intermediate
Clinova Health is a fictional simulated work environment created for the Jay Health Work Experience Programme. It is not a real or verified employer, and this programme is an educational work-experience placement, not employment.
Programme overview
Study how human claim-review reasoning can inform AI-assisted workflows by identifying decision inputs, documenting routine rules and highlighting cases that require human judgement.
AI Claims Review Associate Work Lab
The AI Claims Review Associate Work Lab programme scope centres on documenting rules behind routine claim decisions. Its intended outputs include annotated claim decision examples, routine decision-rule catalogue, human-review exception notes.
What you will do: AI Claims Review Associate Work Lab
- Identify evidence behind routine claim recommendations
- Annotate decision inputs and rule triggers
- Flag uncertain cases for human review
Through role-focused educational assignments at Clinova Health, you will work through case briefs, document the evidence behind your decisions and prepare work samples relevant to documenting rules behind routine claim decisions.
Work you will prepare for review
- Annotated claim decision examples
- Routine decision-rule catalogue
- Human-review exception notes
Methods you will practise
- Decision annotation templates
- Rule and exception worksheets
Your weekly work cycle
- Develop and revise your annotated claim decision examples
- Submit progress on your routine decision-rule catalogue with evidence and outstanding questions
- Discuss documenting rules behind routine claim decisions findings in a supervisor review and record agreed next steps
Feedback and improvement. Your AI Claims Review Associate assignments will be reviewed against the programme’s assessment criteria. You will explain your approach, discuss corrections and refine your deliverables before including permitted samples in your portfolio. The programme runs for 8 weeks, with an expected commitment of 12 hours per week; agreed assignments and review arrangements are confirmed in your enrolment offer.
Role description
Purpose of the role. The AI Claims Review Associate programme develops role-specific judgement and professional work samples through documenting rules behind routine claim decisions. The emphasis is on explaining your approach, producing clear evidence and improving work in response to supervisor feedback.
Work environment. A remote educational AI Claims Review Associate programme set in the fictional Clinova Health environment, with role-focused case briefs, structured assignments and supervisor review.
Day-to-day responsibilities
- Identify evidence behind routine claim recommendations
- Annotate decision inputs and rule triggers
- Flag uncertain cases for human review
Weekly responsibilities
- Develop and revise your annotated claim decision examples
- Submit progress on your routine decision-rule catalogue with evidence and outstanding questions
- Discuss documenting rules behind routine claim decisions findings in a supervisor review and record agreed next steps
Expected deliverables
- Annotated claim decision examples
- Routine decision-rule catalogue
- Human-review exception notes
Reporting and supervision. The AI Claims Review Associate programme scope includes an assigned supervisor reviewing role-specific deliverables, explaining corrections and assessing work against the criteria in your enrolment offer.
Tools and methods relevant to this programme
- Decision annotation templates
- Rule and exception worksheets
Requirements
Qualifications or professional background
- Health, health-informatics, data or insurance background
Required skills
- Analytical thinking
- Spreadsheet confidence
- Written documentation
Preferred skills
- Basic understanding of how rule-based or AI systems work
- Interest in health data
Previous experience. Prior exposure is helpful but not essential.
Digital literacy. Comfortable using web applications, spreadsheets and online communication tools.
Communication. Clear written English and timely responses to team messages and supervisor feedback.
Availability. 12 hours per week for 8 weeks, including scheduled reviews.
Technical requirements. A laptop or desktop computer, a modern browser and a stable internet connection.
Professional and ethical boundaries
- Educational casework only; no employment, real patient care, payer transactions or production system access is implied
- Use only fictional or authorised educational material; do not upload real patient or confidential employer information
- Specialist software, live integrations and dedicated role-specific workflows are not included in the current platform
Expected workload
Hours per week. 12 hours.
Assignment scope. Role-specific case briefs and deliverables focused on documenting rules behind routine claim decisions. Assignment volume and due dates are confirmed in the enrolment offer within the 12-hour weekly commitment.
Deadlines and reporting. Tasks carry individual due dates; a weekly summary is due at the end of each week.
Meetings. One weekly team stand-up and one supervisor review session.
Attendance. Check in and out of the work lab for each working session.
How performance is evaluated
- Accuracy and relevance of annotated claim decision examples
- Evidence and reasoning in routine decision-rule catalogue
- Documentation quality and professional boundaries
- Deadline adherence and response to feedback
Benefits
- Practical work-experience programme
- Access to Remote Career Launchpad
- Free mentor access according to the programme's mentoring arrangements
- Access to the Jay Health job board
- 10% discount on eligible Jay Health courses
- Supervisor feedback
- Opportunity to build a portfolio of permitted work samples
- Performance-based reward eligibility, where applicable (conditional, not guaranteed)
Learning outcomes
By the end of the programme you should be able to:
- Explain the key decisions and standards involved in documenting rules behind routine claim decisions
- Prepare professional annotated claim decision examples
- Prepare professional routine decision-rule catalogue
- Prepare professional human-review exception notes
- Use supervisor feedback to improve the clarity, accuracy and completeness of your work
Selection process
- Application review
- Interview
- Role-relevant assessment
- Acceptance decision
- Enrolment and payment of the ₦20,000 enrolment fee (only after acceptance)
- Onboarding