Claims Senior Business Analyst

Posted 3 Hours Ago
Hiring Remotely in United States
Remote
81K-110K Annually
Senior level
Healthtech
The Role
Lead stakeholder discovery and data-driven analysis for claims processes. Translate findings into system requirements, value propositions, business cases, and roadmap inputs. Document processes and requirements, perform cost-benefit and ROI analysis, partner with cross-functional teams, and communicate insights to influence decisions and support implementation.
Summary Generated by Built In
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The Claims Senior Business Analysis performs analysis of business, process and user needs, documentation of requirements, cost/benefit analysis and translation into proper system requirement specifications. This position will work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Exercises considerable latitude in determining objectives and approaches to assignments.

Key Responsibilities: Discovery, Analysis, & Determining the Value Proposition

  • Lead customer and stakeholder discovery activities (e.g., interviews, usability testing, feedback analysis) to uncover needs, pain points, and opportunities.
  • Analyze customer needs, stakeholder expectations, and relevant data to understand value drivers.
  • Define discovery objectives and scope aligned to product strategy, customer outcomes, and business goals.
  • Translate analytical insights into a clear and compelling value proposition.
  • Partner with stakeholders (engineering, design, marketing, sales, operations) to align product vision, scope, and delivery with the value proposition.
  • Quantify value through business cases, cost–benefit analysis, and ROI assessments.
  • Ensure alignment between the value proposition and organizational strategy and goals.
  • Translate discovery insights into actionable outcomes such as product deliverables, roadmap inputs, and value propositions.
  • Collaborate with cross-functional partners to validate assumptions and support decision-making.
  • Communicate the value proposition effectively to diverse stakeholders.
  • Communicate findings clearly to leadership and teams to support alignment and decision‑making.

Use your skills to make an impact
 

Required Qualifications

  • Minimum 2 years of experience adjudicating claims data and completing data analysis using CAS
  • Working knowledge of ad-hoc query tools and data repositories that support data extraction and manipulation
  • Experience partnering with stakeholders (engineering, design, marketing, sales, operations) to align product vision, scope, and delivery with the value proposition.
  • Experience translating data into presentable information to influence decisions and priorities
  • Experience analyzing processes to identify recommended solutions or re-engineering
  • Demonstrated experience with process documentation, including the use of Microsoft Office applications including Word, Excel, Access, PowerPoint, and Visio

Preferred Qualifications

  • Bachelor's degree
  • Six Sigma certification
  • PMP certification

Additional Information

  • Hours for this position are based on EST or CST.

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.


 

$80,900 - $110,300 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: 07-23-2026
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 at Humana.com and at CenterWell.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.

Skills Required

  • Minimum 2 years of experience adjudicating claims data and completing data analysis using CAS
  • Working knowledge of ad-hoc query tools and data repositories that support data extraction and manipulation
  • Experience partnering with stakeholders (engineering, design, marketing, sales, operations) to align product vision, scope, and delivery with the value proposition
  • Experience translating data into presentable information to influence decisions and priorities
  • Experience analyzing processes to identify recommended solutions or re-engineering
  • Demonstrated experience with process documentation, including use of Microsoft Word, Excel, Access, PowerPoint, and Visio
  • Bachelor's degree
  • Six Sigma certification
  • PMP certification

Humana Compensation & Benefits Highlights

The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Humana and has not been reviewed or approved by Humana.

  • Healthcare Strength Medical, dental, vision, supplemental health, and long-term care insurance are offered alongside on-site/virtual wellness resources and weekly paid well-being time, indicating a whole-person focus.
  • Leave & Time Off Breadth Paid PTO and holidays, volunteer time, and formal leave options such as parental and caregiver time provide broad time-away support. Adoption assistance and lactation rooms extend coverage for key life events.
  • Retirement Support A 401(k) with company match anchors long-term savings. Employer-matched emergency savings programs complement retirement planning.

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The Company
HQ: Louisville, KY
40,741 Employees
Year Founded: 1961

What We Do

At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

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