AVP, Claims

Sun Life; South Portland (ME); Remote; USD 153,000 - 247,000; Full time

Job summary

Sun Life is seeking an Assistant Vice President (AVP) of Claims to lead strategic initiatives across the Stop Loss claims lifecycle. This role focuses on operational excellence, compliance, and enhancing service tools. The ideal candidate will have extensive experience in health insurance and strong leadership skills, contributing to the profitable growth of the Health & Risk Solutions business.

Benefits

Generous vacation and sick time

Market-leading paid family, parental and adoption leave

401(k) employer match

Flexible work environment

Qualifications

• 10+ years relevant expertise and experience, 5+ years in a leadership role.
• 5+ years of Health Insurance or Stop Loss Insurance experience preferred.

Responsibilities

• Provide strategic leadership to the Health and Risk Solutions Stop Loss Claims team.
• Drive operational excellence by advancing claims processes and implementing automation.
• Lead initiatives that advance margin improvement and cost management.

Skills

Leadership

Analytical Skills

Communication

Education

Bachelor's degree

Job description

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.

Job Description:

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Internal candidates are not required to relocate near an office.

The opportunity: The Assistant Vice President (AVP) of Claims is responsible for providing strategic leadership and managing all activities across the entire Stop Loss claims lifecycle. This role ensures compliance, identifies opportunities for continuous improvement, and delivers top-tier operational results to support the profitable growth of our Health & Risk Solutions (H&RS) businesses. The position involves developing and executing strategic initiatives that align with our focus on improving access, managing risk and driving better health outcomes. As a key leader within H&RS, the AVP will have significant external-facing responsibilities and will coordinate with various internal functions including underwriting, distribution, client success, contract issuance, legal and compliance, product development, IT, actuarial, and risk management.

How you will contribute:

• Provide strategic leadership to the Health and Risk Solutions (HRS) Stop Loss Claims team, aligning initiatives with broader company goals.
• Drive operational excellence by advancing claims processes, implementing automation, and enhancing service tools and analytics.
• Leverage advanced analytics, AI, and automation to enhance operational efficiency
• Foster cross-functional partnerships across underwriting, legal, finance, distribution, and IT to ensure seamless claim operations and support business objectives.
• Champion digital transformation and data-driven decision-making to improve claim outcomes and efficiency.
• Cultivate best-in-class claims capabilities, strengthening Sun Life's position as a market leader in Stop Loss claims.
• Lead initiatives that advance margin improvement and cost management across claims operations.
• Support strategic planning and execution of new business initiatives and product development. Provide strategic input on the Clinical 360 program and Health Capabilities.

What you will bring with you:

• Ability to work with a diverse range of people
• 10+ years relevant expertise and experience, 5+ years in a leadership role
• 5+ years of Health Insurance, Group Insurance or Stop Loss Insurance experience (preferred)
• Bachelor's degree required
• Stop Loss or health care industry expert with demonstrated experience managing significant organizational change initiatives
• A deep understanding of the U.S. healthcare delivery system and best practices regarding care and cost management programs
• A working understanding of the many functions required for successful partnership with internal parties, including underwriting, distribution, TPA strategy, and legal and compliance
• Experience with risk based and/or clinical products and services preferred
• Experience overseeing a claims management function
• Excellent leadership skills with a demonstrated ability to build trust, recognize and develop talent, and coach direct reports and others

Salary:

$153,900-$246,200

At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.

#remote

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We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds.

Life is brighter when you work at Sun Life

At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.

We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email [e-mail] request an accommodation.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

We do not require or administer lie detector tests as a condition of employment or continued employment.

Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Category:

Claims - Health & Dental

Posting End Date:

22/06/2025