Process Consultant, Stop Loss Claims

Sun Life Financial; Wellesley (MA); On-site; USD 60,000 - 91,000; Full time

Job summary

Sun Life U.S. is seeking a Process Consultant, Stop Loss Claims to oversee governance, documentation strategy, and continuous improvement across Stop-Loss Claims Operations.

You’ll partner with senior leaders across Claims, Compliance, Quality, Audit, IT, and Learning to reduce variation and drive measurable outcomes. This role requires a seasoned claims professional who can influence beyond authority and design future-ready processes.

Qualifications

• 3+ years of progressive experience in Stop-Loss Claims or complex claims operations.
• Expertise in stop-loss adjudication and regulatory considerations.
• Strong ability to design, govern, and sustain enterprise-level process documentation.
• Excellent written and verbal communication, including executive materials.

Responsibilities

• Support end-to-end governance for Stop-Loss Claims processes, SOPs, templates, and workflows with audit-ready documentation.
• Lead cross-functional process evaluations to identify inefficiencies and gaps and design standardized solutions.
• Partner with Claims Ops, QA, Compliance, Audit, Legal, IT, and Learning to align processes with strategy and risk controls.
• Lead change planning and adoption strategies to ensure smooth implementation of new processes.

Skills

Stop-Loss Claims

Process governance

Regulatory compliance

Audits

Process improvement

Communication

Lean Six Sigma

Visio

Miro

Tools

Visio

Miro

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. At Sun Life, we're driven by our Purpose: helping our Clients achieve lifetime financial security and live healthier lives. Our values shape how we work: caring, authentic, bold, inspiring, and impactful. When you join Sun Life, you'll work with passionate colleagues and empowering leaders who support your growth and celebrate your contributions, so you can make a meaningful difference in our Clients' lives. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.

Job Description: The opportunity: The Process Consultant, Stop Loss Claims is accountable for process governance, end-to-end documentation strategy, and continuous improvement that strengthens quality, compliance, scalability, and risk management within Stop Loss Claims Operations. This role translates complex adjudication and system workflows into standardized, auditable, and future-ready operating models. The role partners closely with senior leaders across Claims, Compliance, Quality, Audit, IT, and Learning to reduce variation, enable change, and drive measurable operational outcomes. This position is suited for an experienced claims professional who influences beyond direct authority, anticipates downstream risk, and elevates the organization through disciplined process design and governance.

How you will contribute

Process Governance & Enterprise Documentation Strategy

Support the end-to-end governance framework for all Stop-Loss Claims processes, SOPs, templates, and workflows. Establish standards for documentation quality, structure, version control, approval, and lifecycle management. Ensure all documentation remains audit-ready and aligns with regulatory requirements, system capabilities, and evolving business strategy. Serve as a primary process SME during internal and external audits, regulatory reviews, and risk assessments. Provide expert guidance to leaders on process controls, documentation risk, and remediation strategies.

Process Excellence, Standardization & Optimization

Lead complex, cross-functional process evaluations to identify inefficiencies, control gaps, and variation impacting quality, cost, or member experience. Design and implement standardized, scalable process solutions that improve accuracy, throughput, and operational resilience. Analyze audit findings, QA trends, operational metrics, and error patterns to inform improvement roadmaps. Apply systems thinking and continuous improvement methodologies to proactively strengthen upstream and downstream processes.

Strategic Stakeholder Partnership

Act as a liaison across Claims Operations, QA, Compliance, Audit, Legal, IT, and Learning & Development. Influence decision-making by clearly articulating risk, impact, and trade-offs tied to process or system changes. Support system and technology initiatives by defining business requirements, documenting future-state workflows, and ensuring operational readiness. Partner with Learning & Development to ensure training strategy and materials accurately reflect approved processes and controls.

Change Leadership & Business Readiness

Lead change planning and communication for complex, multi-stakeholder process initiatives. Develop adoption strategies, and implementation guidance. Coach leaders and teams through change by clarifying expectations, risks, and success measures. Ensure seamless adoption of new or revised processes with minimal disruption to operations.

Quality, Risk & Control Management

Support the linkage between process design, quality outcomes, and regulatory compliance. Proactively identify process-driven risk and recommend mitigation strategies aligned to enterprise risk frameworks. Drive corrective and preventive actions through disciplined updates to procedures, controls, and guidance. Strengthening overall Claims control environment through clarity, consistency, and accountability.

What you will bring with you

3+ years of progressive experience in Stop-Loss Claims or complex claims operations. Expertise in stop-loss adjudication, operational workflows, and regulatory considerations. Proven ability to design, govern, and sustain enterprise-level process documentation. Strong analytical and problem-solving skills with the ability to influence outcomes through insight rather than authority. Exceptional written and verbal communication skills, including executive-level materials. Demonstrated experience with cross-functional process improvement or transformation initiatives. Experience partnering with audit, compliance, risk, or quality organizations. Knowledge of how emerging technologies and AI-enabled solutions (e.g., intelligent document processing, workflow automation, predictive analytics) can enhance business processes. Familiarity with process mapping and documentation platforms (e.g., Visio, Miro, enterprise knowledge repositories). Lean, Six Sigma, or comparable continuous improvement training. Experience supporting large-scale change management or operational readiness efforts.

Salary Range

$60,400 - $90,600

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.

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] to 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: Business Analysis - Process Posting End Date: 21/09/2026

Shine together At Sun Life, you can be your most brilliant self. Our supportive, flexible, and inclusive work environment is one where you – and your career – can thrive. Whatever your aspirations, collaborative leaders and colleagues are ready to help you learn, grow, and succeed. Make life brighter We’re a global company with a passion for people. Our purpose is to help Clients achieve lifetime financial security and live healthier lives. As a team of 30,000 across 26 countries, our impact is far-reaching, and locally relevant There’s power in numbers. As part of Sun Life’s growing team, you have an impact on people in your community and around the world. Shape the future With an optimistic eye on a brighter future, we drive to innovate. Be part of leading change, push boundaries and try new ways of working. Use data to drive bold actions. Be agile and pivot as we test and learn. At Sun Life, we’re driving transformation, sustainability and innovation for our Clients, employees, partners, and communities. Join us. Together, we can make the future brighter. Join a top employer for a brighter future. Visit Sun Life Careers