Top 11 Claims Auditor Certifications

Certifications are important for a claims auditor in the job market because they demonstrate that the individual has met certain standards of knowledge and proficiency in their field. When employers are looking to hire someone, they want to make sure that the person they hire is qualified and knowledgeable in the area of claims auditing. A certification can give employers peace of mind that the individual has been tested and found to be competent in their field. Additionally, certifications may also provide access to higher levels of employment or salary opportunities as they demonstrate a level of expertise and commitment to professional development.

This article reviews some of the top certifications for Claims Auditors and explains how they can help to further a claims auditor's career.

What are Claims Auditor Certifications?

Claims auditor certification is a professional designation which verifies that an individual has met certain standards of knowledge, experience, and training in the field of medical claims auditing. A certified claims auditor is qualified to review, analyze, and audit medical claims in order to ensure accuracy and compliance with regulations. This certification provides employers with assurance that the individual is knowledgeable about all aspects of claims auditing and can properly handle any issues that may arise.

Claims auditors must have an understanding of the various laws, regulations, and processes associated with healthcare insurance billing. They must be familiar with coding systems such as ICD-10 and CPT codes as well as HIPAA privacy laws. Additionally, they should be able to recognize fraudulent or suspicious activity related to healthcare billing.

By obtaining this certification, individuals demonstrate their commitment to providing quality services for their employer or clients. It shows employers that the individual is knowledgeable about medical claims auditing procedures and can help reduce risk within their organization. Furthermore, it gives them confidence in knowing that the individual is qualified to identify problems before they become costly errors or violations of regulations.

Pro Tip: When considering a Claims Auditor Certification, make sure to research the requirements thoroughly. Different certifications may require different levels of experience or education, so it is important to make sure you are applying for the right one. Additionally, many certifications require continuing education to maintain their validity, so be sure to factor this into your decision-making process.

Related: What does a Claims Auditor do?

Top 11 Claims Auditor Certifications

Here’s our list of the best certifications available to Claims Auditors today.

1. Certified Professional Coder (CPC)

Certified Professional Coder (CPC) is a certification program offered by the American Academy of Professional Coders (AAPC). It is designed for individuals who want to become professional medical coders. The certification validates an individual's knowledge and skills in medical coding and billing, as well as their ability to accurately interpret and apply the codes used in healthcare.

To become certified, candidates must pass a comprehensive exam that covers topics such as anatomy and physiology, medical terminology, ICD-10-CM/PCS coding systems, HCPCS Level II coding systems, CPT coding systems, and reimbursement methodologies. The exam is divided into two parts: a written section and a practical section. Candidates must pass both sections of the exam to earn their CPC certification.

The length of time it takes to get your CPC certification varies depending on how much time you can dedicate to studying for the exam. Most people take between 4-6 months of dedicated study time before taking the exam.

To become certified, you will need to register with AAPC and pay an application fee. Once registered, you will have access to resources such as textbooks, practice exams, online courses, webinars, and more that can help you prepare for the exam. After passing the exam, you will receive your CPC certification from AAPC.

The cost of getting your CPC certification varies depending on which resources you use to prepare for the exam. Generally speaking, it costs around $400-$500 for registration fees plus any additional materials or courses you purchase to help with preparation.

2. Certified Fraud Examiner (CFE)

A Certified Fraud Examiner (CFE) is a professional who has been certified by the Association of Certified Fraud Examiners (ACFE). The CFE credential is the world’s most prestigious and recognized anti-fraud certification, and is held by more than 80,000 professionals worldwide.

To become a CFE, an individual must pass a comprehensive exam that tests their knowledge in four key areas: financial transactions and fraud schemes, law, investigation, and criminology. This exam covers topics such as money laundering, identity theft, cybercrime, corporate fraud investigations, forensic accounting techniques, and other related topics.

It typically takes between 6-12 months of preparation to pass the CFE exam. Preparation includes studying the ACFE's study materials and gaining experience in fraud prevention or detection. Many people choose to take a review course offered by an ACFE approved provider or attend seminars to help them prepare for the exam.

The cost of becoming a CFE varies depending on how you choose to prepare for the exam. The cost of taking the exam itself is $400 USD for members of the ACFE ($450 USD for non-members). In addition to this fee there are also costs associated with purchasing study materials or attending review courses or seminars.

3. Certified Internal Auditor (CIA)

Certified Internal Auditor (CIA) is a professional certification offered by the Institute of Internal Auditors (IIA). It is a globally recognized designation that demonstrates an individual’s expertise in internal auditing, control, and compliance. The CIA is one of the most respected credentials in the field of internal auditing.

To become a Certified Internal Auditor, you must meet certain requirements set by the IIA. These include passing a three-part exam, having two years of professional experience in internal auditing or related fields, and agreeing to abide by the IIA Code of Ethics. The exam consists of three parts: Part 1 – Internal Audit Basics; Part 2 – Practice of Internal Auditing; and Part 3 – Business Knowledge for Internal Auditing. Each part has multiple-choice questions and takes approximately four hours to complete.

The cost for taking the CIA exam varies depending on your geographic location and whether or not you are an IIA member. Generally speaking, it will cost between $400-$600 USD per part plus any applicable taxes or fees. Additionally, there may be additional costs associated with study materials such as books or online courses.

Once you have successfully passed all three parts of the CIA exam and met all other requirements, you will receive your certification from the IIA. This process usually takes about six months from start to finish.

4. Certified Government Auditing Professional (CGAP)

Certified Government Auditing Professional (CGAP) is a professional certification offered by the Institute of Internal Auditors (IIA). It is designed for individuals who want to demonstrate their knowledge and skills in government auditing. The CGAP certification provides assurance that the individual has the necessary knowledge and expertise to conduct effective internal audits in government organizations.

The CGAP exam consists of 150 multiple-choice questions, which must be completed within three hours. To become certified, applicants must pass the exam with a score of at least 70 percent. The exam fee is $450 USD.

To become eligible for the CGAP exam, applicants must meet certain requirements, such as having at least two years of experience in government auditing or related fields. They must also complete an approved training program or have a degree from an accredited college or university with a major in accounting, finance, or business administration.

The IIA also requires applicants to maintain their certification by completing continuing professional education credits every year. The cost of maintaining your certification varies depending on your membership status and other factors.

5. Certified Information Systems Auditor (CISA)

Certified Information Systems Auditor (CISA) is a professional certification issued by the Information Systems Audit and Control Association (ISACA). It is designed to recognize individuals who possess the knowledge, skills, and experience necessary to audit, control, monitor and assess an organization’s information technology and business systems.

The CISA certification process involves passing a comprehensive exam that covers topics such as IT governance, risk management, application development, system operations, access control and more. The exam consists of 200 multiple-choice questions and takes approximately four hours to complete.

In order to become certified as a CISA, you must meet certain prerequisites. These include having at least five years of professional experience in information systems auditing or security; earning a bachelor’s degree from an accredited college or university; attending an ISACA-approved training program; and passing the CISA examination.

The cost of obtaining the CISA certification varies depending on your country of residence. In the United States, it typically costs around $700 for the exam fee alone. Additional fees may be required for any courses taken or other materials purchased in preparation for the exam.

6. Chartered Global Management Accountant (CGMA)

Chartered Global Management Accountant (CGMA) is a designation awarded to management accountants who have demonstrated the highest level of competency in their field. It is offered by the American Institute of Certified Public Accountants (AICPA) and the Chartered Institute of Management Accountants (CIMA).

The CGMA designation requires applicants to meet certain educational, professional experience, and examination requirements. To qualify for the CGMA, applicants must have either a bachelor’s degree in accounting or finance from an accredited institution, or five years of professional experience in management accounting. Applicants must also pass two exams: The CIMA Professional Qualification Exam and the AICPA’s Uniform CPA Examination.

It typically takes between 12-18 months to complete all of the requirements for the CGMA designation. Once all requirements are met, applicants will receive their certificate and can use the CGMA designation on business cards and resumes.

The cost of obtaining the CGMA designation varies depending on which exam you take first. The CIMA Professional Qualification Exam costs $1,500 USD while the AICPA’s Uniform CPA Examination costs $3,500 USD. Additionally, there may be additional fees associated with taking practice exams or enrolling in review courses.

7. Certified Public Accountant (CPA)

A Certified Public Accountant (CPA) is a professional designation given to individuals who have met the educational, experience and examination requirements set forth by their state Board of Accountancy. CPAs are qualified to provide a wide range of accounting services, including auditing, tax preparation, financial planning, and consulting.

In order to become a CPA, you must meet certain education and experience requirements that vary by state. Generally speaking, most states require at least 150 semester hours of college coursework with a concentration in accounting or related fields; some states may also require additional coursework in business-related topics such as economics or finance. Additionally, most states require applicants to have at least one year of public accounting experience prior to taking the CPA exam.

The CPA exam is administered by the American Institute of Certified Public Accountants (AICPA). It consists of four sections: Auditing & Attestation (AUD), Business Environment & Concepts (BEC), Financial Accounting & Reporting (FAR), and Regulation (REG). Each section is 4 hours long and tests your knowledge on various topics related to accounting and finance. The exam is offered twice per year in April and October at testing centers throughout the United States.

The cost for taking the CPA exam varies by state but typically ranges from $200-$400 per section. Additionally, there may be other costs associated with becoming a CPA such as application fees or membership dues for professional organizations like the AICPA or your local state society of CPAs.

Overall, it can take anywhere from 6 months to several years to become a CPA depending on how quickly you complete all the necessary steps for licensure.

8. Certified Financial Services Auditor (CFSA)

Certified Financial Services Auditor (CFSA) is a professional certification issued by the Institute of Internal Auditors (IIA). It is designed to recognize individuals who have demonstrated knowledge and expertise in the area of financial services auditing. The CFSA credential is designed for internal and external auditors, compliance personnel, risk managers, and other professionals who work in the financial services industry.

The CFSA program consists of two parts: an online self-study component and an in-person exam. The self-study component includes reading materials and practice questions that cover topics such as risk management, internal controls, audit standards, fraud detection, and regulatory compliance. To qualify for the exam, applicants must have at least two years of experience in financial services auditing or related fields.

The CFSA exam takes approximately four hours to complete and consists of multiple-choice questions covering topics such as financial reporting requirements, audit principles, internal control procedures, fraud prevention techniques, and regulatory compliance issues. The exam fee is $450 USD for members of IIA or $550 USD for non-members.

To maintain the CFSA credential after passing the exam, individuals must complete 40 hours of continuing professional education every three years. They must also adhere to a code of ethics established by IIA and pay an annual maintenance fee of $100 USD.

9. Certified in Control Self-Assessment (CCSA)

Certified in Control Self-Assessment (CCSA) is a professional certification offered by the Institute of Internal Auditors (IIA). It is designed to recognize individuals who have demonstrated a mastery of the knowledge and skills necessary to effectively perform and lead control self-assessment (CSA) activities. The CCSA certification is intended for internal auditors, risk managers, CFOs, controllers, IT auditors, and other professionals involved in CSA activities.

The CCSA certification requires passing an examination that covers topics such as CSA principles, methods, techniques, and tools; planning and organizing CSA engagements; assessing control effectiveness; reporting results; and making recommendations for improvement. The exam consists of 150 multiple-choice questions that must be completed within three hours.

To be eligible for the CCSA exam, applicants must meet certain requirements including having at least two years of experience in internal audit or related fields such as risk management or financial management. Applicants must also complete an online application form with supporting documentation.

The cost of the CCSA exam varies depending on where it is taken. In the United States, it typically costs around $400 USD plus any applicable taxes or fees.

In total, it usually takes about six months to get certified in Control Self-Assessment (CCSA). This includes studying for the exam and completing all required paperwork.

10. Accredited Quality Assurance Professional (AQAP)

Accredited Quality Assurance Professional (AQAP) is a certification program offered by the American Society for Quality (ASQ). This certification is designed to recognize professionals who have demonstrated knowledge, experience, and proficiency in the field of quality assurance.

The AQAP certification requires applicants to have at least three years of professional experience in quality assurance or related fields. Applicants must also pass an exam that covers topics such as quality management systems, process improvement, and statistical analysis. The exam consists of multiple-choice questions and takes approximately three hours to complete.

To obtain the AQAP certification, applicants must first apply online with ASQ. Once approved, they will be assigned an examination date and location. Applicants then need to register for the exam and pay the associated fee. The fee for the AQAP exam is $395 USD for members of ASQ and $495 USD for non-members.

Once an applicant passes the exam, they will receive their certificate within four weeks of passing the exam. The certificate is valid for five years from the date of issue and can be renewed by retaking the AQAP exam every five years.

11. Chartered Institute of Management Accountants (CIMA).

The Chartered Institute of Management Accountants (CIMA) is a professional body for management accountants, offering qualifications in the field of business and finance. It is the world’s largest and leading professional body of management accountants, with over 227,000 members and students in 179 countries. CIMA provides globally-recognized qualifications which are highly sought after by employers worldwide.

It takes approximately three to four years to become a fully qualified CIMA member. The qualification process consists of three stages:

1. Passing the CIMA Professional Qualification exams – these include 15 examinations covering topics such as financial accounting, management accounting, business law and ethics, performance management, corporate governance and risk management.

2. Completing the Strategic Level Case Study – this consists of a written paper and an online case study exam which tests your ability to apply knowledge from across all areas of the syllabus to real life scenarios.

3. Gaining practical experience – you must have at least three years’ work experience in a relevant role before you can become a full member of CIMA. This experience should be gained within five years prior to applying for membership or during your studies if you are already studying for the CIMA qualification.

The cost of becoming a CIMA member depends on where you are studying from and which route you take through the qualification process. Generally speaking, it will cost around £2,500 - £5,000 to complete the entire qualification process including tuition fees and exam fees.

Do You Really Need a Claims Auditor Certificate?

The answer to this question depends on your career goals and the type of work you plan to do. If you are looking to work in a claims auditing role, having a Claims Auditor Certificate may be beneficial in helping you stand out among other applicants and demonstrate your knowledge and skills in the field. Additionally, having a Claims Auditor Certificate could potentially open up more job opportunities and increase your earning potential.

On the other hand, if you do not plan to pursue a career as a claims auditor, or if there are no employers in your area that require this certification, then obtaining a Claims Auditor Certificate is likely not necessary. In some cases, it may still be beneficial to have this certification as it demonstrates that you have taken the initiative to learn about claims auditing principles and best practices.

Ultimately, the decision of whether or not to obtain a Claims Auditor Certificate should depend on your individual situation and career goals.

Related: Claims Auditor Resume Examples

FAQs About Claims Auditor Certifications

1. What is a Claims Auditor Certification?

Answer: A Claims Auditor Certification is a professional certification that validates an individual's knowledge, skills, and abilities in the field of insurance claims auditing. It demonstrates a commitment to excellence in the profession and provides assurance to employers that the individual has met certain standards of practice.

2. Who can obtain a Claims Auditor Certification?

Answer: Any individual who meets the eligibility requirements may apply for a Claims Auditor Certification. Eligibility requirements typically include having at least two years of experience in claims auditing or insurance related activities, and passing an examination administered by an approved organization.

3. How long does it take to become certified as a Claims Auditor?

Answer: The amount of time required to become certified as a Claims Auditor varies depending on the applicant’s experience level and other factors such as their availability for study and preparation for the exam. Generally, it takes between 6-12 months to complete all of the necessary steps for certification.

4. What are some of the benefits of obtaining a Claims Auditor Certification?

Answer: Benefits of obtaining a Claims Auditor Certification include increased credibility within the industry, better job opportunities, higher salary potential, and greater job satisfaction. It also allows individuals to demonstrate their commitment to excellence in their profession and enhances their ability to serve clients more effectively.

5. Are there any continuing education requirements associated with maintaining my Certified Claims Auditor status?

Answer: Yes, most organizations require Certified Claims Auditors to participate in continuing education courses on an annual basis in order to maintain their status and keep up with changes in the field of insurance claims auditing.