Make the call.
Then learn why it gets missed.
ClaimCaliber shows you a real-looking (but fake) medical claim and asks for the call — pay it, deny it, or hold it. Then a veteran examiner walks you through the right answer, the trap most people fall for, and the fix that stops the miss across the whole operation. Free to try, no card.
Improper payments: FFS $31.70B · Part C $19.07B · Part D $3.58B — CMS, FY2024. Examiner judgment is one lever among several.
Every case gives you three things
Most quizzes stop at the right answer. The third one is the point — it's how you stop the mistake across a whole team, not just spot it once.
You make the call
A realistic claim on a clean worktable — eligibility, provider, service lines, prior auth. You decide: pay, deny, pend, or adjust — and get the reasoning for whatever you chose.
A veteran breaks it down
How an experienced examiner actually reads the claim — the tell, the trap, and the thing newer examiners trip on. Plain English, no textbook-speak.
You see how to stop it at scale
How often this slips through, why it happens, and the fix that prevents it across the whole operation — the edit, the plan rule, or the workflow change that catches it next time.
Built for the people who pay claims
The judgment your team makes hundreds of times a day — made trainable, measurable, and consistent.
Health plans & TPAs
Keep the whole team deciding the same way and lower the dollars that leak out on the wrong call — without standing up your own training content.
New-examiner onboarding
Get new hires productive in weeks, not months. They practice on realistic cases and learn the reasoning, not just the click path.
QA & calibration
Give a whole team the same set of judgment calls and see where they diverge — a fast, concrete way to calibrate before it shows up in audit.
Cases from the examiner's seat
A few that separate a calibrated examiner from a fast one — the clean claim you should still deny, the duplicate hiding in history, the pattern you only see from above.
Covered yesterday, not today
A clean, well-coded visit you should still deny — because the patient's coverage had already ended. The gate that comes before everything else.
The claim that came back twice
The same claim shows up twice. Learn how examiners catch true duplicates — the most common way money quietly leaks out.
Every visit is the most complex visit
One high-level visit seems fine — but this provider bills every patient that way. Learn to spot upcoding across a pattern.
Who pays first for the working 67-year-old
The provider billed you second, behind Medicare. Learn how to check who actually pays first instead of just following their lead.
Safe to bring into a health plan
Training for a health plan has to clear compliance and security before anyone hits play. ClaimCaliber was built for that from day one.
Every claim is made up
No real patients, no real providers, no protected health info. Nothing here can leak, so it passes compliance and security review.
Not tied to any insurer
Cases teach the judgment, not one plan's internal edits. Examiners learn the pattern — the kind that transfers across every line of business.
Written by someone who's done the job
Every breakdown is in a veteran examiner's voice — the real tells and traps, not a textbook paraphrase.
Train your examiners on this.
Onboard examiners faster, lower error and rework rates, and get the whole team deciding the same way. Anyone can practice for free; teams get a private case library built around their plans and policies, plus progress tracking for everyone.