ClaimSphere Technologies · AI Claims Automation Specialist
Claims Automation Analyst
3 months · 15 hrs/week · Remote · Advanced
ClaimSphere Technologies 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
Analyse opportunities for claims automation by mapping decision pathways, examining complex exceptions and specifying controls that preserve review quality and human oversight.
Claims Automation Analyst Work Lab
The Claims Automation Analyst Work Lab programme scope centres on exception analysis for complex and escalated claims. Its intended outputs include claims automation process map, exception and control matrix, automation test-scenario specification.
What you will do: Claims Automation Analyst Work Lab
- Map claims decision branches and exception routes
- Assess failure risks in proposed automation steps
- Define test scenarios and human escalation conditions
Through role-focused educational assignments at ClaimSphere Technologies, you will work through case briefs, document the evidence behind your decisions and prepare work samples relevant to exception analysis for complex and escalated claims.
Work you will prepare for review
- Claims automation process map
- Exception and control matrix
- Automation test-scenario specification
Methods you will practise
- Decision tables
- Process maps and test-case worksheets
Your weekly work cycle
- Develop and revise your claims automation process map
- Submit progress on your exception and control matrix with evidence and outstanding questions
- Discuss exception analysis for complex and escalated claims findings in a supervisor review and record agreed next steps
Feedback and improvement. Your Claims Automation Analyst 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 3 months, with an expected commitment of 15 hours per week; agreed assignments and review arrangements are confirmed in your enrolment offer.
Role description
Purpose of the role. The Claims Automation Analyst programme develops role-specific judgement and professional work samples through exception analysis for complex and escalated claims. The emphasis is on explaining your approach, producing clear evidence and improving work in response to supervisor feedback.
Work environment. A remote educational Claims Automation Analyst programme set in the fictional ClaimSphere Technologies environment, with role-focused case briefs, structured assignments and supervisor review.
Day-to-day responsibilities
- Map claims decision branches and exception routes
- Assess failure risks in proposed automation steps
- Define test scenarios and human escalation conditions
Weekly responsibilities
- Develop and revise your claims automation process map
- Submit progress on your exception and control matrix with evidence and outstanding questions
- Discuss exception analysis for complex and escalated claims findings in a supervisor review and record agreed next steps
Expected deliverables
- Claims automation process map
- Exception and control matrix
- Automation test-scenario specification
Reporting and supervision. The Claims Automation Analyst 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 tables
- Process maps and test-case 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. Some relevant work or placement experience is expected.
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. 15 hours per week for 3 months, 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. 15 hours.
Assignment scope. Role-specific case briefs and deliverables focused on exception analysis for complex and escalated claims. Assignment volume and due dates are confirmed in the enrolment offer within the 15-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 claims automation process map
- Evidence and reasoning in exception and control matrix
- 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 exception analysis for complex and escalated claims
- Prepare professional claims automation process map
- Prepare professional exception and control matrix
- Prepare professional automation test-scenario specification
- 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