Note: The job is a remote job and is open to candidates in USA. Humana Inc. is a leading U.S. healthcare company, and they are seeking a Director of Claims Analytics & Analysis to lead a high-impact analytics function. The role focuses on deep investigative analysis of healthcare claims to provide actionable insights for executive leadership, aiming to improve cost, quality, and member experience.
Responsibilities
- 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
Skills
- 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
- An advanced degree in Analytics, Data Science, Health Economics, Finance, or related field preferred (but not required)
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.
- This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
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