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Certificate in Medical Claims Analyst (CMCA)

Job Description

To train learners to accurately analyze, evaluate, and process medical claims using coding standards, documentation review, and regulatory compliance to ensure correct and ethical claims adjudication.


Objective: The Certified Medical Claims Analyst (CMCA) course aims to develop advanced expertise in reviewing, analyzing, and adjudicating medical claims with accuracy and compliance. The program trains learners to interpret medical records, understand clinical terminology, and apply standard coding systems such as ICD, CPT, and HCPCS.

Eligibility Criteria

Criteria 1

Criteria 2

Experience

Training Qualification

12th

Passed

1 Year

None

Degree

Passed

Pursuing Continuous Schooling

None

Degree

Passed

No Experience

None


Sector

Healthcare & Medical Techniques

Certifying Bodies

National Education Training And Development

Type of Organisation

Board of Vocational Education

Occupation Standards/Syllabus

NCO Code

Mandatory/ Optional

Duration

  • Module 1: Introduction to Medical Claims Analysis

  • Module 2: Medical Coding Systems and Clinical Documentation Review

  • Module 3: Claims Processing and Adjudication Procedures

  • Module 4: Insurance Plans, Reimbursement Policies, and Regulatory Standards

  • Module 5: Denials, Appeals, and Claims Audit Techniques

  • Module 6: Advanced Claims Analysis, Reporting, and Professional Ethics






N/A






Mandatory






6 Months




Learning Module In Job Role/Syllabus

Career Opportunities

  • Medical Claims Analyst

  • Health Insurance Claims Processor

  • Claims Verification Officer

  • Senior Medical Claims Analyst

  • Claims Risk & Fraud Analyst

  • Healthcare Data & Claims Specialist

  • Claims Operations Executive

  • Insurance Claims Consultant

  • Claims Team Lead

  • Manager – Medical Claims


Duration Hours

Theory :

150

Practical :

150

Employability Skills :

30

OJT (Mandatory) :

40

  1. Specializations in Course

  1. Senior Medical Claims Analyst

  2. Claims Risk & Compliance Specialist

  3. Healthcare Data & Analytics Officer

  4. Medical Claims Consultant

  5. Manager – Health Insurance Claims


  • High demand across health insurance companies, TPAs, hospitals, healthcare IT, and insurance service providers

  • Focus on claims analysis, risk detection, compliance, and process efficiency

  • Exposure to insurance policies, claim adjudication systems, fraud detection, and regulatory compliance

  • Critical role in ensuring accurate claim settlements, minimizing organizational risk, and improving operational efficiency

  • Ideal for professionals targeting careers in medical claims analysis, insurance operations, and healthcare finance


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