Certificate in Medical Claims Analyst (CMCA)

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

Learning Module In Job Role/Syllabus

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

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

Specializations in Course

Senior Medical Claims Analyst
Claims Risk & Compliance Specialist
Healthcare Data & Analytics Officer
Medical Claims Consultant
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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