ClaimCaliber Information

ClaimCaliber is judgment training for health-plan claims examiners. Claims adjudication runs on judgment — and that judgment is mostly learned the slow, expensive way: on the job, one mistake at a time. New examiners take months to get sharp, veterans still disagree on the hard calls, and every wrong call costs money and rework at scale. ClaimCaliber makes that judgment trainable. Examiners work real-shaped claims (fully synthetic — no PHI), make the adjudication call — pay, deny, pend, adjust — and immediately see how a veteran examiner reads it, plus the upstream systems fix that keeps the miss from happening again. The library spans the calls examiners make every day: coding, eligibility, prior authorization, modifiers, place of service, duplicates, coordination of benefits, bundling, pricing, member cost-share, and fraud, waste & abuse. It's built like real skill-building, not a quiz. Mastery tracking by category, spaced repetition that resurfaces what you miss, and an adaptive path that meets each learner at their level mean the practice compounds — you don't "finish" it, you get sharper. Who it's for: • Individual claims examiners building speed, accuracy, and confidence • L&D and operations teams onboarding new examiners and calibrating experienced ones — without waiting for real claims to teach the lesson Sharper calls, more consistent decisions across a team, and fewer costly misses — competency you can actually see and measure. Raise the caliber of every call. claimcaliber.com