Make the call.
Then see why it gets missed at scale.
ClaimCaliber shows you a synthetic medical claim and asks for the adjudication call — pay, deny, pend, or adjust. Then it gives you two things back: a veteran examiner's teardown of the right answer, and the systems-level view of the edit, rule, or workflow that prevents the miss upstream.
Improper payments: FFS $31.70B · Part C $19.07B · Part D $3.58B — CMS, FY2024. Examiner judgment is one lever among several.
Every scenario has three beats
Anyone can publish a quiz that stops at the right answer. The third beat is the point.
The call
A synthetic claim on a clean examiner worktable — eligibility, provider, service lines, prior auth. You pick the disposition and get the rationale for whatever you chose.
The teardown
How a veteran examiner actually reads the claim — the tell, the trap, and the thing newer examiners trip on. Plain English, in the examiner's voice.
The systems view
How often it's missed, the root cause, and the upstream fix — the edit, plan-config rule, training gap, or workflow redesign that prevents it at scale.
Sample scenarios
Four cases — one per difficulty, spanning distinct categories — so you can see the full arc end to end: the call, the teardown, and the upstream fix.
The claim that sat in a drawer
What is the correct disposition for this claim?
Covered yesterday, not today
What is the correct disposition for this claim?
The claim that came back twice
What is the correct disposition for this claim?
The line that won't pass edits
One field on this claim makes it fail edits. Which one?
Built to clear procurement
Health-plan training has to survive a compliance review before anyone presses play. This is built for that from the ground up.
Synthetic & vendor-neutral
Every claim, member, and provider is fabricated. No PHI, not tied to any payer — it clears procurement review.
No real adjudication data
Scenarios teach the judgment, not a specific plan's edits. You learn the pattern that transfers across payers.
Built by an examiner
Teardowns are written in a veteran examiner's voice — the tells and traps, not a textbook paraphrase.
Train your examiners on this.
ClaimCaliber is a learning-and-development tool for claims teams — onboard examiners faster, lower error and rework rates, and standardize judgment. The public simulator is free; team deployments add a private, tailored library and progress tracking.