How To Become A Claim Auditor: What It Is and Career Path

What is a claim auditor and how to become one

Updated January 8, 2025

4 min read

A claim auditor's job involves analyzing payments, procedures, and guidelines of benefits. They interpret detailed reports and other various documents to determine the eligibility of the claimant and the type of service they can avail.

As a claim auditor, their duty is to monitor claim financials and/or set reserves, perform routine follow-ups for all pending claims and open reserves, and review all aspects of claims liability and accurately adjudicate the claim according to complex contractual obligations. They also maintain quality, quantity, and turn-time standards. A claims auditor job requires a bachelor's degree in accountancy or commerce along with three plus years of claims auditor experience. Good analytical and problem solving skills and ability to exercise good judgment in complex or difficult claim situations is important. A claims auditor must provide service to both the customer and company and also have ethical values.

The average hourly pay for the position is $24.41, which amounts to $50,768 annually. The career is also projected to grow in the near future and create new job opportunities across the United States.

ScoreClaim AuditorUS Average

Salary

3.7

Avg. Salary $46,802

Avg. Salary $59,228

Stability level

7.0

Growth rate 6%

Growth rate 0.3%

Diversity

6.4

Race

American Indian and Alaska Native 0.46%

Asian 12.20%

Black or African American 8.56%

Hispanic or Latino 10.90%

Unknown 3.96%

White 63.93%

Gender

female 76.11%

male 23.89%

Age - 43

Race

American Indian and Alaska Native 3.00%

Asian 7.00%

Black or African American 14.00%

Hispanic or Latino 19.00%

White 57.00%

Gender

female 47.00%

male 53.00%

Age - 43

Stress level

7.0

Stress level is high

7.1 - high

Complexity level

8.9

Complexity level is advanced

7 - challenging

Work life balance

4.1

Work life balance is poor

6.4 - fair

Key steps to become a claim auditor

Explore claim auditor education requirements

Most common claim auditor degrees

Bachelor's

45.0 %

Associate

24.3 %

High School Diploma

10.6 %

Start to develop specific claim auditor skills

Skills	Percentages
Medical Terminology	9.08%
Medicaid	8.22%
Patients	6.01%
HCPCS	5.21%
CMS	5.08%

Complete relevant claim auditor training and internships

Accountants spend an average of 6-12 months on post-employment, on-the-job training. New claim auditors learn the skills and techniques required for their job and employer during this time. The chart below shows how long it takes to gain competency as a claim auditor based on U.S. Bureau of Labor Statistics data and data from real claim auditor resumes.

Research claim auditor duties and responsibilities

Work with department analyst to create measurement tools and methods for communicating results and managing QA analysis in compiling/reporting results.
Bill and prepare claims appeals for Medicare, Medicaid, and private payers.
Review medical records and charges of hospital, ambulatory surgery and physician bills to verify CPT, ICD-9 and HCPCS codes.
Research and determine accuracy of ICD-9 and CPT codes on CMS 1500 and UB 92 claims forms on a daily basis.

Prepare your claim auditor resume

When your background is strong enough, you can start writing your claim auditor resume.

You can use Zippia's AI resume builder to make the resume writing process easier while also making sure that you include key information that hiring managers expect to see on a claim auditor resume. You'll find resume tips and examples of skills, responsibilities, and summaries, all provided by Zippi, your career sidekick.

Choose from 10+ customizable claim auditor resume templates

Build a professional claim auditor resume in minutes. Browse through our resume examples to identify the best way to word your resume. Then choose from 10+ resume templates to create your claim auditor resume.