Top 12 Claims Auditor Skills to Put on Your Resume

Standing out as a claims auditor takes a sharp mix of technical horsepower and people sense. Precision matters. Speed matters. Judgment matters even more. Below, you’ll find twelve skills that signal real capability on a resume—and in the day-to-day grind of audits that actually move the needle.

Claims Auditor Skills

1. Excel
2. SQL
3. Auditing
4. Analytics
5. Compliance
6. Risk Assessment
7. Tableau
8. SAS
9. Fraud Detection
10. Claims Management
11. Data Mining
12. Communication

1. Excel

Excel is the workhorse for organizing, testing, and explaining claims data—quick pivots, tidy models, and clear outputs that tell the story without drama.

Why It's Important

It speeds analysis, supports reconciliation, and flags anomalies before they become expensive headaches. Clean structure, fewer errors, faster reviews.

How to Improve Excel Skills

Build depth where it counts:

1. Advanced formulas: Prioritize XLOOKUP, INDEX/MATCH, SUMIFS, IFERROR, and dynamic arrays like FILTER, UNIQUE, SEQUENCE.
2. Pivot mastery: Grouping, calculated fields, slicers, timelines, and pivot charts for instant drilldowns.
3. Data validation: Controlled inputs, drop-downs, custom rules—stop errors at the door.
4. Power Query + Power Pivot: Clean, shape, and model multi-table data. Refresh beats rework.
5. Conditional formatting: Heatmaps, outlier highlights, duplicate checks—visual signals, fast.
6. Macros/VBA (practical): Automate repetitive checks, report packaging, and formatting tasks.
7. Clear visuals: Focus on legible charts, labels, and layouts that decision-makers understand instantly.

Get fast. Get consistent. Then get curious with what-if analysis and scenarios.

How to Display Excel Skills on Your Resume

2. SQL

SQL turns sprawling claims databases into precise answers. It’s how you pull, join, and slice data without guesswork.

Why It's Important

Audit trails live in the data. SQL exposes inconsistencies, duplicate activity, and odd patterns across tables—quickly and defensibly.

How to Improve SQL Skills

1. Own the basics: SELECT, WHERE, GROUP BY, HAVING, ORDER BY, and joins of every flavor.
2. Model complexity: Use CTEs, subqueries, and window functions like ROW_NUMBER(), RANK(), LAG()/LEAD().
3. Aggregate well: SUM, COUNT, AVG, MIN, MAX—with thoughtful grouping and filters.
4. Optimize: Read execution plans, index smartly, avoid SELECT *, and keep predicates sargable.
5. Data hygiene: Cast types explicitly, handle nulls, standardize keys and dates, document assumptions.
6. Safety and governance: Use least-privilege access, respect PI/PHI rules, and keep scripts versioned.
7. Practice with real cases: Replicate audit questions and build reusable queries you trust.

How to Display SQL Skills on Your Resume

3. Auditing

Auditing means verifying claims records, controls, and processes—testing not just numbers, but the logic behind them.

Why It's Important

It protects accuracy, confirms compliance, and builds trust. Stakeholders want proof, not promises.

How to Improve Auditing Skills

1. Risk-based planning: Focus on material exposure, control design, and where misstatements love to hide.
2. Sampling discipline: Use statistical methods and targeted sampling; document criteria and exceptions cleanly.
3. Workpapers that stand up: Clear objectives, procedures, evidence, and conclusions—tight and review-ready.
4. Tech-enabled testing: Apply analytics for 100% population checks when feasible; keep scripts reproducible.
5. Standards and ethics: Stay current on auditing standards, independence, and documentation requirements.

How to Display Auditing Skills on Your Resume

4. Analytics

Analytics turns raw claims data into signals—trends, outliers, and suspicious clusters you can act on.

Why It's Important

It sharpens detection, speeds investigations, and supports decisions with evidence instead of intuition.

How to Improve Analytics Skills

1. Data quality first: Build validation checks, reconcile sources, and track lineage. Bad inputs poison insights.
2. Core methods: Outlier detection, cohort analysis, time series, segmentation, and correlation checks.
3. Responsible ML: Start simple (rules + scoring), then graduate to interpretable models. Monitor drift.
4. Useful visuals: Dashboards with clear KPIs, thresholds, and drilldowns. Less ornament, more signal.
5. Feedback loops: Close the loop with SIU, adjusters, and compliance to refine rules and models.

How to Display Analytics Skills on Your Resume

5. Compliance

Compliance means your audits track with laws, regulations, and internal policy—no shortcuts, no surprises.

Why It's Important

Mishandled data or noncompliant processes invite penalties, legal issues, and reputational damage. Precision here is protective.

How to Improve Compliance Skills

1. Know the rules: Keep a living library covering federal, state, and industry standards (e.g., HIPAA where applicable, state insurance regulations, privacy obligations).
2. Map controls to risks: Tie procedures to specific requirements; trace every test to a control and owner.
3. Automate checks: Use policy rules, alerts, and audit trails in your tooling to reduce manual misses.
4. Train regularly: Short refreshers beat long seminars. Focus on real scenarios and recent changes.
5. Document decisions: Maintain evidence, rationales, and remediation plans with timestamps and approvals.
6. Promote a speak-up culture: Make it safe to flag issues early. Small catches prevent big problems.

How to Display Compliance Skills on Your Resume

6. Risk Assessment

Risk assessment identifies where claims can go wrong—financially, operationally, or from a compliance angle—and ranks what to tackle first.

Why It's Important

Resources are finite. Solid risk assessment directs attention to the highest-impact exposures and keeps the overall portfolio steady.

How to Improve Risk Assessment Skills

1. Adopt a framework: Anchor to proven approaches (e.g., COSO, ISO 31000) for consistent, comparable scoring.
2. Quantify where possible: Likelihood x impact, control strength, trend direction—make it measurable.
3. Use analytics: Score risks with data (frequency, severity, spikes, seasonality). Update as patterns shift.
4. Tool the process: Maintain a risk register, heat maps, owners, and due dates. Track remediation to done.
5. Collaborate widely: Claims ops, SIU, legal, IT, vendors—diverse inputs sharpen the map.

How to Display Risk Assessment Skills on Your Resume

7. Tableau

Tableau turns dense datasets into interactive dashboards—patterns pop, oddities glow, and leaders get clarity fast.

Why It's Important

Visuals accelerate audit conversations, cut back-and-forth, and help non-analysts see the “so what” immediately.

How to Improve Tableau Skills

1. Prep like a pro: Clean joins, correct data types, consistent date handling, and well-named fields.
2. Calculated fields + LOD: Build reusable logic and level-of-detail expressions for precise aggregations.
3. Parameters and actions: Add interactivity—dynamic thresholds, drill-throughs, and cross-filtering.
4. Design for speed: Use extracts when appropriate, reduce marks, and optimize filters. Performance matters.
5. Dashboard storytelling: Start with the metric that matters, then add context and detail-on-demand.

How to Display Tableau Skills on Your Resume

8. SAS

SAS delivers sturdy analytics for regulated environments—repeatable code, auditable logs, and deep statistical tooling.

Why It's Important

For high-volume claims, SAS handles ingestion, transformation, and analysis with reliability and traceability.

How to Improve SAS Skills

1. Data step fluency: Imports, merges, KEEP/DROP, arrays, and robust error handling.
2. Procedures that matter: PROC SQL, PROC FREQ, PROC MEANS/SUMMARY, PROC UNIVARIATE, PROC REPORT.
3. Macro power: Parameterize repetitive tasks and standardize audits with macro libraries.
4. Documentation baked-in: Use comments, titles/footnotes, and ODS outputs that explain themselves.
5. Performance: Index smartly, minimize sorts, and watch I/O. Large datasets deserve respect.

How to Display SAS Skills on Your Resume

9. Fraud Detection

Fraud detection blends rules, patterns, and instincts—catching inconsistencies before they drain the bottom line.

Why It's Important

Every prevented payout protects reserves and deters repeat behavior. It’s defense and deterrence in one motion.

How to Improve Fraud Detection Skills

1. Define red flags: Duplicate claims, unusual timing, mismatched providers, sudden spikes, network ties.
2. Hybrid approach: Combine business rules with machine learning for coverage across known and unknown schemes.
3. Network and linkage analysis: Surface relationships across claimants, adjusters, providers, and incidents.
4. Benford and outliers: Simple statistical screens catch messy manipulation faster than you’d expect.
5. Tight feedback: Validate alerts with SIU, measure precision/recall, and tune thresholds to control false positives.

How to Display Fraud Detection Skills on Your Resume

10. Claims Management

Claims management covers the full arc—FNOL to settlement. For auditors, it means testing accuracy, timeliness, and adherence to policy at every turn.

Why It's Important

Strong processes reduce leakage, improve customer outcomes, and keep regulators calm. Sloppy workflows do the opposite.

How to Improve Claims Management Skills

1. Map the journey: Document handoffs, SLAs, controls, and bottlenecks. Fix the slowest link first.
2. Automate wisely: Straight-through processing for routine claims; smart triage for complex cases.
3. Data discipline: Standard codes, clean notes, consistent reserves, and auditable changes.
4. Subrogation and recovery: Track opportunities early; build triggers so they aren’t missed.
5. Continuous review: Periodic file audits, leakage studies, and targeted coaching for recurring issues.

How to Display Claims Management Skills on Your Resume

11. Data Mining

Data mining sifts the haystack—patterns, clusters, and signals that explain loss drivers and expose risky behavior.

Why It's Important

It reveals what raw summaries miss: subtle correlations, emerging fraud rings, process drift, and savings opportunities.

How to Improve Data Mining Skills

1. ETL excellence: Reliable pipelines with clear transformations and checks for completeness and accuracy.
2. Feature engineering: Ratios, time deltas, frequencies, and text-derived features from adjuster notes.
3. Techniques that work: Clustering for segments, classification for risk, anomaly detection for the weird stuff.
4. NLP on unstructured data: Keywords, sentiment, entity extraction—turn text into signals.
5. Model governance: Versioning, validation, monitoring, and periodic recalibration to avoid drift.

How to Display Data Mining Skills on Your Resume

12. Communication

Communication is the bridge—translating findings into actions teammates accept and leadership backs.

Why It's Important

Even airtight analysis stalls without clear messaging. Precision in words drives precision in outcomes.

How to Improve Communication Skills

1. Active listening: Clarify goals, confirm facts, and reflect back what you’ve heard before recommending.
2. Crisp writing: Executive summaries up front, bullets for decisions, appendices for evidence.
3. Audience-first: Tailor tone and depth for adjusters, SIU, compliance, or executives—never one-size-fits-all.
4. Visual storytelling: Charts with context, not clutter. Label the “so what.”
5. Constructive feedback: Focus on behaviors and outcomes. Invite critique of your own work too.
6. Calm escalation: When stakes rise, stick to facts, options, and impacts. No theatrics, just clarity.

How to Display Communication Skills on Your Resume