Against the backdrop of the nationwide advancement of standardized, normalized, and convenient administrative services, coupled with the deepening of the "streamlining administration, delegating power, and optimizing services" reforms in the healthcare security sector, county-level medical insurance service windows serve as the core public service platforms through which the public receives medical insurance benefits, interprets medical insurance policies, and addresses livelihood-related appeals. Consequently, the efficiency of their human resources largely determines the quality of public service delivery and the credibility of government departments. As the core production factor for enhancing the quality and efficiency of these windows, human resources—encompassing the overall competence of the workforce, the degree of person-post alignment, and the supporting management mechanisms—jointly constitute the key variables that constrain the release of service efficiency at the windows. Taking the medical insurance service windows of multiple counties and districts in Huai'an City as the subjects of investigation, this study conducts empirical research. At the current stage, grassroots medical insurance windows generally face practical constraints such as an imbalanced personnel identity structure, rigidified assessment mechanisms, monotonous incentive approaches, insufficiently targeted training systems, imperfect talent retention mechanisms, and weak management mechanisms, leaving the value of human capital insufficiently activated. Within the analytical framework of human capital theory, equity theory, and management by objectives theory, this study systematically reviews the operational status of human resource management in county-level medical insurance windows, precisely identifies the multidimensional shortcomings in their efficiency-building efforts, and conducts an in-depth analysis of the underlying causes at the levels of institutional design, management philosophy, and resource guarantees. On this basis, the study constructs a closed-loop efficiency enhancement strategy system encompassing "dynamic person-post adaptation, tiered and categorized assessment, multidimensional and multi-faceted incentives, laddered training and development, full-cycle talent retention, and digital management empowerment". The findings are intended to provide localized theoretical references and practical solutions for optimizing the human resource allocation model of county-level medical insurance windows, alleviating the occupational burnout of frontline service personnel, and activating the intrinsic motivation of practitioners, thereby reinforcing the talent foundation for the high-quality development of grassroots healthcare security public services.