Roleplay: Health Insurance Claim Escalation
Elena received a $1,240 provider bill after an imaging claim showed denial code PA-17, “authorization not found.” The provider told her an authorization exists under fictional reference HPA-4472. Prior representatives told her someone would look into it but did not create a documented claim-review case. Your task is to protect privacy, acknowledge the repeat-contact failure, explain what the denial currently means without implying a final coverage decision, and use the approved claim-review workflow.
- 15 min session
- Difficulty: hard
- 4 objections
The scenario
Elena Park, a member of fictional HarborPoint Health. Elena is calling for the third time about a $1,240 imaging claim that currently shows as denied. She is anxious about the bill and angry that the prior calls produced no reference number or follow-up. She will resist repeating identity verification because she already did it twice, but will comply if the representative explains the privacy reason calmly. She wants certainty; she will accept a well-owned review and follow-up, but not another blind transfer or a vague promise to “check on it.”
Elena received a $1,240 provider bill after an imaging claim showed denial code PA-17, “authorization not found.” The provider told her an authorization exists under fictional reference HPA-4472. Prior representatives told her someone would look into it but did not create a documented claim-review case. Your task is to protect privacy, acknowledge the repeat-contact failure, explain what the denial currently means without implying a final coverage decision, and use the approved claim-review workflow.
Opening line
“This is my third call about the same $1,240 bill. I already verified everything twice, so please don't make me start over again.”
What you'll practice
What gets scored
A scoring syllabus, not a vague impression.
Scoring syllabus
6 graded modules
01Privacy & Verification
20%
Whether the representative protected member information and completed verification before claim discussion.
02Empathy & De-escalation
20%
Acknowledging the repeat-contact failure and financial anxiety before explaining process.
03Accuracy & Plain-language Explanation
20%
Explaining the current claim status and next step accurately without jargon or guarantees.
04Ownership & Resolution
20%
Whether the representative creates and owns the correct claim-review action during the contact.
05Expectations & Documentation
10%
Setting an accurate timeframe, follow-up commitment, and documented handoff.
06Communication
10%
Clear, respectful, non-clinical communication throughout a high-stress member interaction.
Expect these pushbacks
Why do I have to verify again? Your people already know who I am.
So you're saying the MRI isn't covered and I'm stuck with this bill?
The last two people said they would handle it. Why should I believe you?
I cannot pay $1,240. Can you guarantee this will be fixed before it goes to collections?
Questions before you start
Know exactly what happens next.
No mystery trial, surprise subscription, or generic practice prompt.
Is this template free to practice?
Yes. This template is free — every new account gets one free session of about five minutes with an overall score and brief feedback, no credit card required.
How does scoring work?
Your session is graded against a weighted rubric with 6 categories, including how you handled the objections above. Full paid sessions include detailed, evidence-based feedback, a transcript, and speaking analytics.
What happens after I finish?
You get an overall score plus category-level feedback as soon as evaluation completes, usually within a minute or two of ending the session.
Can I redo this template?
Yes. You can rerun the same template as many times as your voice or video minute balance allows and compare how your score changes. Purchased minutes never expire.