Claims Analytics & Analysis Director

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* 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. This role sits beyond dashboards and standard reporting and operates as a strategic thought partner to Claims and Enterprise leaders.

This leader will build and scale a team that translates signals from existing dashboards, operational metrics, and claim detail data into early insights, root cause diagnoses, and solution pathways that 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 executivedecision‑making with scenario analysis, impact sizing, andtrade‑offperspectives.

** 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, whileremainingfocused on 
** problem solving vs. model building** .

+ Rapidly prototype analyses to test hypotheses andvalidatesignals.

** 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 theyhave not.

+ Ability to…