Claims Analytics & Analysis Director

Become a part of our caring community The Director of Claims Analytics & Analysis will lead a high‑impact analytics function focused ondeep investigative analysis of claims operations to surface root cause drivers, emerging trends, and actionable insights for executive leadership. This role sitsbeyond dashboards and standard reportingand operates as a strategic thought partner to Claims and Enterprise leaders. This leader will build and scale a team that translatessignals from existing dashboards, operational metrics, and claim detail dataintoearly insights, root cause diagnoses, and solution pathwaysthat improve cost, quality, efficiency, and member/provider experience. We are seeking a dynamic Director of Claims Analytics & Analysis to join the team! The ideal candidate is a natural problem finder, intellectually curious, and operationally fluent in healthcare claims — someone who instinctively asks “why”, knows where to dig, and can convert ambiguity into structured insight and action. Key Outcomes of the Role 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.” Core Responsibilities Claims Insight Generation & Root Cause Analytics 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 . Strategic Advisory & Executive Engagement 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. Advanced Analytics & Tooling (Applied, Not Academic) 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. Cross - Functional Partnership 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. Use your skills to make an impact Required Qualifications 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. Preferred Qualifications An advanced degree in Analytics, Data Science, Health Economics, Finance, or related field preferred (but not required). Additional Information This role is not eligible for work visa sponsorship. Work at Home Requirements To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $184,800 - $254,100 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities. Application Deadline 07-06-2026 About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our #J-18808-Ljbffr Humana Inc