Predictika · Third-party claims administration program quotes

An AI sales agent's claims program quote, checked before it goes out

An AI sales agent prepares a quote for a third-party claims administration program, with a claims line, a client type, technology and risk control services, a term and a discount. Before it goes out, the agent sends it to Predictika, which checks it against a declarative model of the program options and returns a verdict and every reason.

Scope: Claims administration program quotes: nine claims lines, Litigation Management, Loss Control, Safety Training, Claims Investigations, and the Luminos RMIS, GBGO mygbclaim and Waypoint technology options. See everything this validator covers

This validator models claims program quotes, not just the scenarios shown below.

  • Claims lines and client types — workers compensation, auto, general, professional and executive, employment practices, product and healthcare professional liability, property and cyber and tech E&O, for self-insured employers, captives and insurance carriers, with the claim volume each line needs.
  • Services and technology — Litigation Management, Loss Control priced per site, Safety Training, Claims Investigations priced per investigation, and the Luminos RMIS, GBGO mygbclaim and Waypoint options with the lines and dependencies each one has.
  • Term, discount, fee and reviews — the program term, the discount limit, the annual fee stated on the quote against the computed one, and the reviews that deep discounts, very large claim volumes, long terms and captives on specialty lines need.

Any claims program quote that touches these rules is in scope — not only the scenarios pictured here. Not covered: brokerage placements, benefits and reinsurance. Claims line and service names follow Gallagher Bassett's public pages; the rules, thresholds and all prices are modeled, not published by Gallagher Bassett, and the prices are illustrative.

The AI sales agentBuilds the claims program quote from the conversation and says it is ready.
Predictika validatorChecks every rule at once and returns the verdict, each finding, and the computed figures.

6 scenarios in 3 groups · each group runs from the agent’s first attempt to the outcome · click one to switch

What the agent proposes

The AI sales agent says

Illustrative agent statement. The validator receives the structured request below.

Proposing agent: AI sales agent (scripted)

Before sending, the agent must call Recorded run

Predictika validator


      

        
        
        
      

      
Waiting for the call.

      
    

  

  
  

    
Where rules-based CPQ gets it wrong
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Our assessment of what a typical rules-based CPQ (product rules, price rules and validation rules, as in Salesforce CPQ) does with the same cases. It is a judgment about effort and reliability, not a claim that nothing can be built.

    
What the validator caughtTypical rules-based CPQPredictika
Services offered on some claims lines onlyOnly with care
GBGO mygbclaim, Loss Control, Safety Training and Litigation Management each need their own list of lines.		The line and every service are in one request and checked together on every call.
Technology that depends on other technologyOnly with care
Waypoint needs Luminos RMIS on the same program, which is a rule that looks back at another choice.		All options are fields of one request, so a missing dependency is found in any order.
Volumes and counts behind each serviceOnly with care
Loss Control needs sites, investigations need a count and litigated claims cannot exceed the claims expected.		The counts and the services they belong to are checked together on every call.
Claim minimums, term and discount limitsOnly with workarounds
The minimum claims differ by line, and the term and discount each have a limit and an approval band.		The line, claims, term and discount are checked together, and the approvals come back with the blocks.
Stated annual fee against the computed feeOnly with workarounds
The fee depends on the line, claims, services, counts and discount, so any change has to be recomputed.		The stated fee is a field of the quote and is compared with the computed one on every call.
Every problem returned in one answerOnly with workarounds
Rules tend to fire as a step is completed, so a rep often fixes one error and meets the next.		All findings come back together, whatever order the choices arrived in.

  

  

    
What this validator catches: findings from its test cases
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Every rule is checked on every call, in any order the choices arrive; one problem never hides another. Blocking findings stop the quote; approval findings need a person to sign off; everything else is computed.

    
1The quote expects 19 claims a year; this line needs at least 20 for a claims program.
2The term is 6 years; programs run 1 to 5 years.
3A term of 6 years locks the per-claim rate and needs a person to approve.
4A term of 5 years locks the per-claim rate and needs a person to approve.
5GBGO mygbclaim first-notice-of-loss intake is offered only on Workers Compensation, Auto, General Liability and Property.
6Waypoint decision support needs the Luminos RMIS on the same program.
7Litigation Management is for liability lines; it is not quoted on a Property program.
8The quote has 500 litigated claims but only 400 expected claims.
9Loss Control and Safety Training are quoted only with Workers Compensation, Auto, General Liability or Product Liability programs.
10Loss Control is priced per site and the quote lists no sites.
11Claims Investigations is priced per investigation and the quote lists none.
12The discount of 12 percent is above 8 percent and needs a manager to approve.
13The quote gives a 16 percent discount; more than 15 percent is not allowed.
14The quote states an annual fee of 1,000; the quoted services give 482,600.
156,000 claims a year is above 5,000; a person should confirm the staffing plan.
16A captive client on a specialty liability line needs a person to review the reporting terms.

  

  

    
Scenarios and results
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The recorded result of the validator for each scenario on this page: the request the AI agent sent, the verdict, and every finding, in the order they appear above.

    
1. Property claims program: A quote for a six-year property claims program with technology and risk control services

    
The agent's request. Please quote a six-year property claims program for a self-insured employer, with 19 claims a year, with GBGO mygbclaim, Waypoint decision support, Litigation Management for 30 litigated claims, Loss Control with no sites listed and Safety Training, and a 5 percent discount. The quote states an annual fee of $130,530. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Claim volume below the line minimum. The quote expects 19 claims a year; this line needs at least 20 for a claims program.
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  • Term outside 1 to 5 years. The term is 6 years; programs run 1 to 5 years.
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  • Waypoint needs Luminos RMIS. Waypoint decision support needs the Luminos RMIS on the same program.
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  • Litigation Management on a Property program. Litigation Management is for liability lines; it is not quoted on a Property program.
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  • More litigated claims than claims. The quote has 30 litigated claims but only 19 expected claims.
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  • Risk control on a non-risk-control line. Loss Control and Safety Training are quoted only with Workers Compensation, Auto, General Liability or Product Liability programs.
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  • Loss Control without sites. Loss Control is priced per site and the quote lists no sites.
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  • Long term rate lock. A term of 6 years locks the per-claim rate and needs a person to approve.
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2. Property claims program: The agent resubmits after fixing the errors

    
The agent's request. Please quote a three-year workers compensation claims program for a self-insured employer, with 400 claims a year, with Luminos RMIS, GBGO mygbclaim, Waypoint decision support, Litigation Management for 30 litigated claims, Loss Control at 4 sites and Safety Training, and a 5 percent discount. The quote states an annual fee of $482,600. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Fee summary. Annual fee 482,600 after discount (508,000 before), 1,447,800 for the term.
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3. Cyber claims program: A quote for a cyber claims program with intake, loss control and investigations

    
The agent's request. Please quote a one-year cyber and tech E&O claims program for a self-insured employer, with 40 claims a year, with Luminos RMIS, GBGO mygbclaim, Waypoint decision support, Litigation Management for 5 litigated claims, Loss Control with no sites listed, Safety Training and Claims Investigations with no count listed, and an 18 percent discount. The quote states an annual fee of $130,790. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • GBGO mygbclaim not offered on this line. GBGO mygbclaim first-notice-of-loss intake is offered only on Workers Compensation, Auto, General Liability and Property.
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  • Risk control on a non-risk-control line. Loss Control and Safety Training are quoted only with Workers Compensation, Auto, General Liability or Product Liability programs.
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  • Loss Control without sites. Loss Control is priced per site and the quote lists no sites.
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  • Claims Investigations without a count. Claims Investigations is priced per investigation and the quote lists none.
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  • Discount over 15 percent. The quote gives a 18 percent discount; more than 15 percent is not allowed.
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4. Cyber claims program: The agent resubmits after fixing the errors

    
The agent's request. Please quote a one-year cyber and tech E&O claims program for a self-insured employer, with 40 claims a year, with Luminos RMIS, Waypoint decision support, Litigation Management for 5 litigated claims and Claims Investigations for 12 investigations, and a 5 percent discount. The quote states an annual fee of $145,255. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Fee summary. Annual fee 145,255 after discount (152,900 before), 145,255 for the term.
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5. Large claims program: A quote for a five-year program with 6,000 claims a year

    
The agent's request. Please quote a five-year workers compensation claims program for a self-insured employer, with 6,000 claims a year, with Luminos RMIS, GBGO mygbclaim, Waypoint decision support, Litigation Management for 300 litigated claims, Loss Control at 4 sites and Safety Training, and a 12 percent discount. The quote states an annual fee of $5,000,000. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Stated annual fee does not match. The quote states an annual fee of 5,000,000; the quoted services give 5,229,840.
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  • Discount above 8 percent. The discount of 12 percent is above 8 percent and needs a manager to approve.
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  • Very large claim volume. 6,000 claims a year is above 5,000; a person should confirm the staffing plan.
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  • Long term rate lock. A term of 5 years locks the per-claim rate and needs a person to approve.
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6. Large claims program: The agent resubmits after fixing the errors

    
The agent's request. Please quote a five-year workers compensation claims program for a self-insured employer, with 6,000 claims a year, with Luminos RMIS, GBGO mygbclaim, Waypoint decision support, Litigation Management for 300 litigated claims, Loss Control at 4 sites and Safety Training, and a 12 percent discount. The quote states an annual fee of $5,229,840. It is ready to send.

    
Verdict: Needs approval.

    
    
      
  • Discount above 8 percent. The discount of 12 percent is above 8 percent and needs a manager to approve.
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  • Very large claim volume. 6,000 claims a year is above 5,000; a person should confirm the staffing plan.
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  • Long term rate lock. A term of 5 years locks the per-claim rate and needs a person to approve.
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  • Fee summary. Annual fee 5,229,840 after discount (5,943,000 before), 26,149,200 for the term.
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Narration transcript
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The text of the narrated walkthrough, step by step.

    
    
      
  1. Welcome to a demo of Predictika's Validator. An AI sales agent prepares a quote for a third-party claims administration program, with a claims line, a client type, technology and risk control services, a term and a discount. Before it goes out, the agent sends it to Predictika, which checks it against a declarative model of the program options and returns a verdict and every reason.
    2. 
      
  2. I will start with the first request by the agent.
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  3. The agent says. Please quote a six-year property claims program for a self-insured employer, with 19 claims a year, with GBGO mygbclaim, Waypoint decision support. The quote states an annual fee of $130,530. The rest of the request is on screen.
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  4. Before it goes out, the agent calls the validator.
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  5. Blocked, with seven findings and one approval, all in one answer. The quote expects 19 claims a year; this line needs at least 20 for a claims program. The term is 6 years; programs run 1 to 5 years. Waypoint decision support needs the Luminos RMIS on the same program. The other four are on screen.
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  6. The validator returned seven blocking findings and one approval in one answer. A check that reads one field at a time would pass most of this; it shows only when the choices in the quote are checked against each other.
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  7. What this shows: for claim minimums, term and discount limits, a rules-based CPQ can do this only with workarounds.
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  8. Now the agent resubmits.
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  9. The corrected request. It changes the claims line to workers compensation, the expected claims per year to 400, the term to 3 years, the Luminos RMIS to yes, the Loss Control sites to 4 and the stated annual fee to $482,600.
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  10. It calls the validator again.
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  11. This time the validator clears it.
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  12. All eight earlier findings are cleared.
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  13. Eight problems caught in one call, fixed in one pass, and a clean quote. That is the value of Predictika's validator: catching mistakes before they reach the customer. Now you can try the other scenarios yourself.
    14.