Claims Analytics & Analysis Director

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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 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 dataintoearly 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.

• 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.

• 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…