Description

Course Name: Certificate in Health Insurance Claims Management

Global Occupational Skill Standard – GOSS ID: GOSS/HF/CHICM/V1

Eligibility: 10+2 (Higher Secondary) or Equivalent.

Duration: Three Months.

Objective: The Certificate in Health Insurance Claims Management course is designed to provide participants with the skills and knowledge required to efficiently manage health insurance claims and coordinate healthcare billing processes. The program covers the fundamentals of health insurance policies, patient eligibility verification, medical coding, and claims submission procedures.

Get ready to join the Journey to become a GSDCI Certified Professional  – International Certification and Assessment Body.

Steps to become a GSDCI Certified Professional:

Step 1: Select your certification you want to pursue.

Step 2: Click on get certified tab, new pop up window will open.

Step 3: Click on pay certification fee, you will be redirected to billing details page.

Step 4: Fill your details and click on pay certification fee, you will be redirected to payment gateway, pay fee by any available options like Card (Debit/Credit), Wallet, Paytm, Net banking, UPI and Google pay.

Step 5: You will get Login Credentials of Online E-Books and Online assessment link on your email id, within 48 hrs of payment.

Step 6: After completion of the online assessment, the soft copy of your certificate will be sent to your registered email ID within 5 days.

Assessment Modules:

Module 1: Introduction to Health Insurance: Overview of Health Insurance, Types of Health Insurance Plans, Key Terminology in Health Insurance, Role of a Health Insurance Coordinator, Legal and Ethical Considerations, Importance of Insurance in Healthcare

Module 2: Medical Coding and Billing Basics: Introduction to ICD-10 Coding, CPT and HCPCS Codes, Understanding Diagnosis vs Procedure Codes, Coding Guidelines and Conventions, Common Coding Errors, Documentation Requirements for Accurate Billing

Module 3: Claims Processing and Management: Overview of Claims Processing, Insurance Verification and Eligibility, Claim Creation and Submission, Electronic vs Paper Claims, Payment Posting and Reconciliation, Denials and Appeals Handling

Module 4: Healthcare Regulations and Compliance: HIPAA Overview and Patient Privacy, Fraud, Waste, and Abuse in Healthcare, Compliance Programs and Audits, Understanding Payer Policies, Legal Responsibilities of Claims Coordinators, Ethical Practices in Health Insurance

Module 5: Advanced Claims Coordination: Coordination of Benefits (COB), Handling Complex Claims, Managed Care and Network Considerations, Working with Multiple Payers, Claim Follow-Up and Tracking, Reporting and Analysis of Claims Data

Module 6: Professional Skills and Career Development: Effective Communication with Patients and Providers, Time Management and Organizational Skills, Using Practice Management Software, Problem-Solving in Claims Coordination, Continuous Learning and Certification, Career Advancement Strategies

GSDCI Online Assessment Detail:

• Duration- 60 minutes.
• Number of Questions- 30.
• Number of Questions from each module: 5.
• Language: English.
• Exam Type: Multiple Choice Questions.
• Maximum Marks- 100, Passing Marks- 50%.
• There is no negative marking in any module.

Marking System:
S.No.	No. of Questions	Marks Each Question	Total Marks
1	10	5	50
2	5	4	20
3	5	3	15
4	5	2	10
5	5	1	5
	30		100
How Students will be Graded:
S.No.	Marks	Grade
1	91-100	O (Outstanding)
2	81-90	A+ (Excellent)
3	71-80	A (Very Good)
4	61-70	B (Good)
5	50-60	P (Pass)
6	0-49	F (Fail)

 

Benefits of Certification:

1. Global Recognition & Credibility – Stand out worldwide with a certification that strengthens your professional profile across borders and demonstrates your skills to employers and institutions.

2. Quality Assurance through ISO Certification – Programs follow an ISO-certified quality management system to promote consistency, reliability, and a standardized learning experience.

3. Career Advancement & Employability – Enhance your résumé, demonstrate professional competence, and improve your prospects for career growth, promotions, or suitable job opportunities.

4. Non-Profit Trust Factor – Certification from a non-profit organization reflects a mission-driven approach focused on skill development, professional learning, and public benefit.

5. Access to Learning Resources – Gain access to useful learning resources such as e-books, mock tests, assessments, and online academic support.

6. Transparency & Online Verification – Each certification includes a unique enrolment or certificate ID, enabling convenient online verification by employers and other interested parties.

7. Lifetime or Long-Term Validity – Certifications may offer lifetime or extended validity, reducing the need for frequent renewal, subject to the applicable certification scheme.