Screening LLM Judges Without Ground Truth: A Preliminary Evaluation of an AI Dental Hygiene Coach

Researchers increasingly use Large Language Models as judges (LLM-as-a-judge) to evaluate model outputs. Yet there are no standards for how to design these judges. Typically, researchers choose the prompt, rating scale, and model intuitively. If these choices change the judge's verdicts, two studies can reach different conclusions about the same facts. To address this risk and to provide an empirical basis for judge designs, we evaluate 10 reasoning models across multiple designs on two tasks: a scalar rating of sentence sentiment and toxicity (over 500 items per category), as well as a binary accuracy classification of question-answer pairs (n=600). For the rating tasks, despite judges showing significant disagreements with the human ground truth, the practical size of differences is small enough to consider most judges reliable (mean absolute deviation of 0.11 points on a 1 - 7 scale); toxicity judges even outperform standard classifiers. Judges are also highly accurate on average (96.5%) for the accuracy classification task. However, design choices can produce shifts: changing the rating scale alone can shift measured bias by up to 0.93 points (rating task), and while accuracy levels are rarely impacted, design choices consistently impact judge leniency (classification task; leniency drop of 28.9 percentage points when using detailed prompts, and up to 56.1 percentage points when switching models). Counterintuitively, lower reasoning effort affects neither accuracy nor leniency. Across both tasks, model identity is the dominant source of variance. These findings suggest that while LLM judges are broadly trustworthy in aggregate, design choices can be meaningful sources of variance. Given the growing reliance on automated evaluation in LLM research, we intend this study as a methodological reference for designing more robust and replicable LLM-as-a-judge pipelines.

We propose a scalable, validity-oriented pipeline for evaluating biomedical LLM judges when high-quality human judgments are scarce. First, we augment existing human-labelled biomedical benchmarks with deterministic, metric-grounded mutations that produce auditable preference pairs. Second, we evaluate judges beyond aggregate correctness using three deployment-relevant dimensions: correctness against metric-derived gold labels, robustness under repeated stochastic sampling, and compliance with the requested output format. We use this pipeline to assess Llama-3.1-8B-Instruct under four regimes: (1) base, using the instruct model as is; (2) SFT, distillation-based supervised fine-tuning only; (3) RL, GRPO-based reinforcement learning only; and (4) SFT$\rightarrow$RL, SFT followed by RL. The base and single-stage regimes struggle on structured medical discrimination such as PICO extraction and clinical calculations, whereas SFT$\rightarrow$RL performs best across correctness, compliance, and robustness; gains concentrate on decomposable tasks (PICO, MedCalc), at times matching or outperforming frontier models.

LLM-as-a-Judge has become the dominant evaluation paradigm for language models, but judge validation in practice relies on exact-match agreement, a metric that does not correct for chance and systematically overstates discriminative ability. We present the largest systematic evaluation of LLM-as-a-Judge to date: 21 judges from nine providers across MT-Bench, JudgeBench, and RewardBench, evaluated under three protocols (agreement, consistency, bias audit) over 118 runs and approximately 541,000 individual judgments. Four findings emerge, consistent across the full cohort, including the April 2026 frontier: kappa deflation between exact match and Cohen's kappa is universal (33--41 pp on MT-Bench), judge rankings shift by up to 14 positions across benchmarks, high test--retest reliability (>0.95) coexists with severe position bias (>0.10) in two production-deployed judges (instantiating a consistency--bias paradox), and verbosity bias is small (<0.011) across our cohort under a single pairwise rubric. We distill these into a Minimum Viable Validation Protocol.