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Benefits vendor performance scorecard

Builds a structured performance scorecard evaluating a benefits carrier or broker across five weighted dimensions — SLA adherence, cost management, employee satisfaction, service and account management, and compliance…

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Purpose

Convert scattered vendor data — SLA reports, invoices, escalation logs, employee survey results, and compliance notices — into a single weighted scorecard that grades a carrier or broker across five dimensions and produces a defensible renewal recommendation. Solves the problem of vendor reviews being anecdotal and renewal decisions being driven by inertia rather than evidence.

When to Use

Invoke this skill when the user asks to:

  • Evaluate a benefits carrier or broker's performance against SLAs and contract commitments
  • Prepare a quarterly or annual vendor business review (QBR/ABR)
  • Build a data-backed case for or against a renewal
  • Score an incumbent vendor before going to market or issuing an RFP
  • Standardize how the benefits team reviews all vendors year over year
  • Compare two or more vendors on a consistent, weighted rubric

Inputs Required

Before starting, collect:

  • Vendor name and type: Carrier (medical/dental/vision/life/disability), broker/consultant, or third-party administrator
  • Review period: The date range being scored (e.g., plan year, trailing 12 months, or specific quarter)
  • SLA performance data: Contracted service levels and actual results — claims turnaround, call answer/abandon rates, appeal resolution time, implementation milestones
  • Cost data: Fees or premiums vs. budget/target, renewal rate history, any credits or penalties, and cost per employee or per transaction if available
  • Employee experience signals: Survey scores (NPS/CSAT), enrollment support feedback, complaint or escalation volume, and portal usability comments
  • Service and account management notes: Responsiveness, escalation handling, proactivity, QBR quality, and turnover in the account team
  • Compliance status: ACA/ERISA/HIPAA obligations, 5500 support, notice delivery, audit findings, and any regulatory or data-breach incidents

If quantitative SLA or cost data is incomplete, score the available dimensions and flag any dimension graded on partial data so the reader can weigh confidence accordingly.

Instructions

Step 1: Set the Scoring Framework

Grade each of the five dimensions on a 0–100 scale, then apply default weights (adjust and note if the user specifies different priorities):

  • SLA Adherence — 30%
  • Cost Management — 25%
  • Employee Satisfaction — 20%
  • Service & Account Management — 15%
  • Compliance — 10%

Convert each dimension score to a letter grade and produce a weighted composite:

  • A: 90–100 / B: 80–89 / C: 70–79 / D: 60–69 / F: below 60

State the weights explicitly at the top so the scorecard is auditable and repeatable next cycle.

Step 2: Score SLA Adherence (30%)

Evaluate contracted service levels against actuals. For each SLA, compare target vs. actual and classify: Met / Missed / At Risk.

  • Weight the most member-impacting SLAs highest: claims accuracy, claims turnaround time, call abandonment rate, appeal/grievance resolution time, and implementation timeliness
  • Penalize repeated misses more heavily than one-off misses — a consistent pattern is a systemic issue
  • Note whether SLA penalties in the contract were actually invoked and credited
  • Score reflects the percentage of member-weighted SLAs met, adjusted down for any SLA missed two or more consecutive periods

Step 3: Score Cost Management (25%)

Assess financial performance and predictability.

  • Compare actual fees/premiums to budget and to the original renewal quote
  • Analyze renewal rate history — flag any renewal above medical trend or above the market benchmark for the coverage line
  • Verify all promised credits, guarantees (e.g., performance guarantees, rate caps), and pass-through savings were delivered
  • For brokers: assess commission/fee transparency and whether compensation was disclosed and reasonable for scope
  • Downgrade for surprise costs, mid-year rate actions, or opaque fee structures even when the headline number is acceptable

Step 4: Score Employee Satisfaction (20%)

Translate the member experience into a grade.

  • Weight survey scores (NPS/CSAT) and complaint/escalation volume relative to enrolled population
  • Assess open-enrollment and life-event support quality — the highest-visibility moments for members
  • Evaluate digital experience: portal usability, mobile access, ID card and EOB delivery
  • Factor in resolution quality, not just volume — high escalation volume that resolves fast is different from low volume that never resolves

Step 5: Score Service & Account Management (15%)

Evaluate the working relationship and vendor proactivity.

  • Responsiveness against expected turnaround for standard requests
  • Escalation handling: does the account team own problems or route them into a black hole?
  • Proactivity: did the vendor surface cost-saving ideas, plan design insights, or compliance updates unprompted?
  • QBR/reporting quality: are reviews data-rich and forward-looking or a slideshow of activity?
  • Account team stability: turnover and continuity of the assigned team

Step 6: Score Compliance (10%)

Assess regulatory reliability and risk exposure.

  • Timeliness and accuracy of required notices and filings (ACA reporting, SBCs, 5500 support, COBRA/HIPAA obligations as applicable)
  • Any audit findings, corrections, or regulatory actions during the period
  • Data security posture and any privacy or breach incidents involving member data
  • Treat any breach, missed statutory filing, or unresolved audit finding as an automatic red flag regardless of the numeric score

Step 7: Identify Red Flags

Separate from the grades, list any findings that warrant attention regardless of composite score:

  • Consecutive SLA misses on member-impacting metrics
  • Undisclosed or unexplained fees, or renewal above trend without justification
  • Compliance incident, missed filing, or open audit finding
  • Account team turnover disrupting service continuity
  • Declining satisfaction trend across two or more periods

Step 8: Produce the Renewal Recommendation

Deliver a clear, opinionated verdict tied to the composite score and red flags:

  • Renew (strong performance, no material red flags)
  • Renew with corrective action plan (adequate but with specific, dated remediation items and re-measurement triggers)
  • Market test / go to RFP (persistent underperformance or a red flag that erodes confidence)
  • Do not renew (compliance failure, unresolved breach, or sustained failure across multiple dimensions)

Include 3–5 negotiation levers for the next contract (e.g., add performance guarantees, tighten SLA definitions, cap renewal rate, require dedicated account manager, add audit rights).

Output Format

  • Structure: Header block with vendor, period, and weights → dimension-by-dimension scorecard → summary table → red flags → recommendation with negotiation levers
  • Length: 900–1,300 words
  • Format: Structured document with a summary scorecard table (dimension, weight, score, letter grade) plus prose analysis per dimension and a bulleted red-flag and recommendation section
  • Sections: Scorecard Summary (with composite) → SLA Adherence → Cost Management → Employee Satisfaction → Service & Account Management → Compliance → Red Flags → Renewal Recommendation & Negotiation Levers
  • Tone: Benefits director conducting a vendor review — evidence-based, direct, and decision-oriented; grades are defended with the underlying data, not asserted

Quality Checklist

Before delivering output, verify:

  • [ ] All five dimensions are scored, each with a numeric score and letter grade
  • [ ] The summary table shows dimension, weight, score, and grade, and the weighted composite is calculated correctly
  • [ ] Weights are stated explicitly and sum to 100%
  • [ ] Every dimension score is justified with at least one specific data point from the inputs — no grade stands unsupported
  • [ ] Any dimension graded on partial or missing data is flagged as such
  • [ ] A single renewal recommendation is stated (one of the four verdicts) — no hedging — with 3–5 negotiation levers

Notes

  • Weights are defaults for a typical carrier review; broker/consultant reviews often warrant shifting weight toward Service & Account Management and Cost transparency — adjust and state the change
  • A high composite score does not override a compliance red flag; treat statutory failures and data breaches as veto conditions on renewal
  • Run this scorecard on the same rubric each cycle so year-over-year trends become visible — trend direction is often more telling than any single period's grade
  • For multi-vendor comparisons, apply the identical weights to each vendor so composites are directly comparable

How to use this skill

This file is a Claude Code skill in Anthropic's standard format — markdown with YAML frontmatter at the top.

Installing in Claude Code:

  • ~/.claude/skills/<folder-name>/SKILL.md — auto-loads in every session anywhere on your machine (recommended for skills you'll use across multiple projects)
  • <your-project>/.claude/skills/<folder-name>/SKILL.md — auto-loads only when working in that project (recommended for project-specific skills)

Restart Claude Code or open a new session to register.

Using in Claude.ai, ChatGPT, Gemini, or other AI tools:

  1. Drag this file into a new chat, or copy and paste its contents
  2. Send your task or request as your next message — the AI will apply the skill where it fits

For Claude Code skill details: https://docs.anthropic.com/en/docs/claude-code/skills