Curriculum architecture

Structured learning tied to claims operations.

Each path combines knowledge development, applied practice, and controlled competency evidence. Public descriptions remain intentionally high level.

Path 01

Claims Intake & Documentation Control

Build control at the point where claims information enters the workflow.

  • Required field and source verification
  • Jurisdiction and date-of-service confirmation
  • Documentation completeness and classification
  • Routing, status, ownership, and audit requirements
  • Applied lab: identify intake control failures in a de-identified scenario
Path 02

Workers’ Compensation Reimbursement

Develop a defensible foundation for state-governed reimbursement review.

  • Workers’ compensation fundamentals and terminology
  • Jurisdiction and effective-date controls
  • CPT, HCPCS, ICD, DRG, modifiers, and bundling concepts
  • Fee-schedule and variance-review principles
  • Applied lab: evaluate a controlled reimbursement scenario
Path 03

Appeals & Recovery Readiness

Strengthen the evidence, documentation, and decision trail behind escalation.

  • Denial and adjustment classification
  • Appeal-candidate readiness
  • Evidence and calculation narratives
  • Citation support and deadline awareness
  • Applied lab: complete an appeal-readiness assessment
Path 04

Revenue Integrity & Claim Validation

Connect validation, reconciliation, QA, and defensible reporting.

  • Validation checkpoints and exception handling
  • Financial reconciliation and variance identification
  • Documentation quality and peer-review controls
  • Corrective routing and escalation
  • Applied lab: review a de-identified claim-control packet
Path 05

Global Claims Communication

Support multilingual communication while preserving protected values and review boundaries.

  • Terminology and numeric-value preservation
  • Qualified-review boundaries
  • Traceability and controlled-use readiness
  • Operational and legal communication context
  • Applied lab: review a multilingual output-control summary
Path 06

Claims Governance Leadership

Translate claims activity into accountable, measurable execution.

  • RACI and role accountability
  • Workflow governance and escalation standards
  • Team competency and quality monitoring
  • Resource governance and version control
  • Applied lab: identify governance gaps in a team workflow
Credential framework

ClaimCalcPro™ competency certificates

Credentials document completion of ClaimCalcPro™ learning requirements. They are not represented as accredited continuing-education or third-party professional certifications.

Claims Operations Foundations

Intake, documentation, jurisdiction, workflow status, and basic governance.

WC Reimbursement Analyst

Coding, fee-schedule concepts, variance review, and documentation controls.

Appeals & Recovery Specialist

Denial review, evidence readiness, deadlines, and escalation controls.

Revenue Integrity Professional

Validation, reconciliation, quality review, and audit readiness.

Claims Governance Leader

Governance, accountability, reporting, and enterprise implementation.