How would an evaluation score an agent on a hospital insurer remittance?

A hospital's patient accounts team receives insurer remittance `REM-3382` covering six claims for a total of 4,215.60. Four claims are paid in full, one is paid at a reduced contracted rate, and one is denied with code `CO-45`. Patient account `PAT-8841` has a co-payment balance linked to the reduced claim.

In the evaluation, the agent is asked to allocate the remittance against open claims `CLM-2001` to `CLM-2006`. The grader holds the expected result: five claim postings, a contractual adjustment on the reduced claim, a transfer of the co-payment to patient responsibility, and an exception case for the denied claim routed to the denials team.

One run posts the denied claim as paid because it forced the total to reconcile. The grader sees the ledger balance as correct but fails the run on three checks: the denied claim shows a zero balance, no exception exists, and the patient's statement omits the co-payment. Another run posts five claims correctly but forgets the co-payment transfer, and earns partial credit.

**What it teaches:** totals can reconcile while the case is wrong. Score each claim-level outcome and each side effect separately, and report them as a profile so you can see which skill is missing.