Curogram Health · Claims Operations Specialist
Claims Examiner
2 months · 12 hrs/week · Remote · Foundation
Curogram 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
Develop a disciplined approach to examining outpatient health-insurance claims: establish eligibility, interpret benefits, reconcile billed services and explain a recommended decision.
Claims Examiner Work Lab
The Claims Examiner Work Lab programme scope centres on outpatient claims with straightforward benefit checks. Its intended outputs include outpatient claim examination files, benefit and tariff reconciliation notes, decision rationales with supporting evidence.
What you will do: Claims Examiner Work Lab
- Check outpatient claims for complete service information
- Compare benefits, tariffs and authorisation details
- Write a decision rationale and flag unresolved evidence
Through role-focused educational assignments at Curogram Health, you will work through case briefs, document the evidence behind your decisions and prepare work samples relevant to outpatient claims with straightforward benefit checks.
Work you will prepare for review
- Outpatient claim examination files
- Benefit and tariff reconciliation notes
- Decision rationales with supporting evidence
Methods you will practise
- Claim review checklists
- Benefit schedules and tariff worksheets
Your weekly work cycle
- Develop and revise your outpatient claim examination files
- Submit progress on your benefit and tariff reconciliation notes with evidence and outstanding questions
- Discuss outpatient claims with straightforward benefit checks findings in a supervisor review and record agreed next steps
Feedback and improvement. Your Claims Examiner 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 2 months, 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 Claims Examiner programme develops role-specific judgement and professional work samples through outpatient claims with straightforward benefit checks. The emphasis is on explaining your approach, producing clear evidence and improving work in response to supervisor feedback.
Work environment. A remote educational Claims Examiner programme set in the fictional Curogram Health environment, with role-focused case briefs, structured assignments and supervisor review.
Day-to-day responsibilities
- Check outpatient claims for complete service information
- Compare benefits, tariffs and authorisation details
- Write a decision rationale and flag unresolved evidence
Weekly responsibilities
- Develop and revise your outpatient claim examination files
- Submit progress on your benefit and tariff reconciliation notes with evidence and outstanding questions
- Discuss outpatient claims with straightforward benefit checks findings in a supervisor review and record agreed next steps
Expected deliverables
- Outpatient claim examination files
- Benefit and tariff reconciliation notes
- Decision rationales with supporting evidence
Reporting and supervision. The Claims Examiner 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
- Claim review checklists
- Benefit schedules and tariff worksheets
Requirements
Qualifications or professional background
- Background in nursing, pharmacy, medicine, health records, health insurance or a related field
- Final-year students in health disciplines may apply
Required skills
- Attention to detail
- Basic medical terminology
- Structured written explanations
Preferred skills
- Exposure to HMO or insurance processes
- Familiarity with ICD-10 or tariff schedules
Previous experience. No previous experience required.
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 2 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. 12 hours.
Assignment scope. Role-specific case briefs and deliverables focused on outpatient claims with straightforward benefit checks. 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 outpatient claim examination files
- Evidence and reasoning in benefit and tariff reconciliation notes
- 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 outpatient claims with straightforward benefit checks
- Prepare professional outpatient claim examination files
- Prepare professional benefit and tariff reconciliation notes
- Prepare professional decision rationales with supporting evidence
- 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