ClaimSphere Technologies · Claims Operations Specialist
Claims Quality Associate
8 weeks · 12 hrs/week · Remote · Intermediate
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
Build second-level review skills by assessing whether completed claim examinations are accurate, adequately documented and consistent with the applicable review standards.
Claims Quality Associate Work Lab
The Claims Quality Associate Work Lab programme scope centres on second-level checks on completed claim reviews. Its intended outputs include scored second-level review samples, correction recommendations, claims quality findings report.
What you will do: Claims Quality Associate Work Lab
- Sample completed reviews for quality checks
- Compare recommendations against supporting evidence
- Classify errors and draft corrective feedback
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 second-level checks on completed claim reviews.
Work you will prepare for review
- Scored second-level review samples
- Correction recommendations
- Claims quality findings report
Methods you will practise
- Quality scoring rubrics
- Claim sampling and error logs
Your weekly work cycle
- Develop and revise your scored second-level review samples
- Submit progress on your correction recommendations with evidence and outstanding questions
- Discuss second-level checks on completed claim reviews findings in a supervisor review and record agreed next steps
Feedback and improvement. Your Claims Quality 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 Claims Quality Associate programme develops role-specific judgement and professional work samples through second-level checks on completed claim reviews. The emphasis is on explaining your approach, producing clear evidence and improving work in response to supervisor feedback.
Work environment. A remote educational Claims Quality Associate programme set in the fictional ClaimSphere Technologies environment, with role-focused case briefs, structured assignments and supervisor review.
Day-to-day responsibilities
- Sample completed reviews for quality checks
- Compare recommendations against supporting evidence
- Classify errors and draft corrective feedback
Weekly responsibilities
- Develop and revise your scored second-level review samples
- Submit progress on your correction recommendations with evidence and outstanding questions
- Discuss second-level checks on completed claim reviews findings in a supervisor review and record agreed next steps
Expected deliverables
- Scored second-level review samples
- Correction recommendations
- Claims quality findings report
Reporting and supervision. The Claims Quality 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
- Quality scoring rubrics
- Claim sampling and error logs
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. 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 second-level checks on completed claim reviews. 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 scored second-level review samples
- Evidence and reasoning in correction recommendations
- 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 second-level checks on completed claim reviews
- Prepare professional scored second-level review samples
- Prepare professional correction recommendations
- Prepare professional claims quality findings report
- 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