Claims Analytics Director

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $184.8k - $254.1k / year

⏰ Full Time

🔴 Lead

👔 Director

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

⚕️ Healthcare Insurance

Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• The Director of Claims Analytics & Analysis will lead a high‑impact analytics function focused on deep investigative analysis of claims operations to surface root cause drivers, emerging trends, and actionable insights for executive leadership. • Identify root cause drivers behind claims performance trends (cost, leakage, rework, denials, timeliness, provider abrasion, member impact). • Detect early warning signals from claims data and operational metrics before they appear as lagging KPIs. • Provide clear, executive ‑ ready narratives that connect data to business drivers to recommended actions. • Deliver effective senior executive level communication and engagement. • Build and lead a strategic claims analytics team that complements (not duplicates) reporting and data science functions. • Elevate analytics from “what happened” to “why it’s happening and what to do next.” • Investigate trends surfaced in claims dashboards and operational metrics to uncover underlying drivers, process failures, policy impacts, and behavioral patterns. • Lead structured root cause analyses across claim types, product lines, providers, vendors, and workflows. • Translate complex findings into clear, actionable insights for Claims Operations and executive leadership. • Proactively surface issues and opportunities without waiting for formal asks — this role is expected to find the problems. • Serve as a trusted analytics advisor to senior Claims, Clinical, and Enterprise leaders. • Synthesize insights into concise executive narratives, not technical readouts. • Frame findings in terms of financial impact, operational risk, member experience, compliance, and scalability. • Support executive decision ‑ making with scenario analysis, impact sizing, and trade ‑ off perspectives. • Leverage AI, machine learning, and advanced analytics as tools, not ends in themselves, to accelerate insight generation and pattern detection. • Partner with data science and reporting teams as needed, while remaining focused on problem solving vs. model building. • Rapidly prototype analyses to test hypotheses and validate signals. • Collaborate closely with Claims Operations and Technology partners. • Ensure insights are grounded in real operational context, not abstract metrics. • Support continuous improvement initiatives and transformation efforts with data-backed insight.

🎯 Requirements

• 10+ years in healthcare analytics, with deep exposure to claims operations (payer-side strongly preferred) • Bachelor’s degree required • Proven experience translating claims data into business insights and operational recommendations • Demonstrated success building or leading analytics teams aligned to business operations • Experience partnering with senior executives and influencing decisions with data • Exceptional problem-solving and root cause analysis skills • Strong instinct for where to investigate when metrics move — and when they have not • Ability to connect granular claims data to enterprise-level outcomes • Advanced analytics literacy (SQL, Python, statistical techniques, AI-enabled analysis), applied pragmatically • Ability to understand code and work closely with technical teams • Outstanding communication and storytelling skills — able to simplify complexity • Demonstrated ability to articulate ideas effectively in both written and oral forms.

🏖️ Benefits

• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, paid parental and caregiver leave) • short-term and long-term disability • life insurance • many other opportunities