Stop-Loss Claims Process Architect

Sun Life; Baltimore (MD); On-site; USD 60,000 - 91,000; Full time

Benefits offered by this job

Vacation & sick time

401(k) match

Stock purchase plan

Life insurance

Disability benefits

Sabbatical

Job summary

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

You will translate complex adjudication workflows into auditable, scalable operating models and partner with senior leaders to reduce variation and strengthen compliance. This role requires 3+ years in Stop-Loss Claims or complex claims operations, expertise in adjudication and regulatory considerations, and a proven ability to

Qualifications

• 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 AI-enabled solutions can enhance business processes.
• Familiarity with process mapping and documentation platforms (Visio, Miro, knowledge repositories).
• Lean, Six Sigma, or comparable continuous improvement training.
• Experience supporting large-scale change management or operational readiness efforts.

Responsibilities

• 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.
• 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.
• 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 reflect approved processes and controls.
• 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.
• 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.
• Strengthen overall Claims control environment through clarity, consistency, and accountability.

Skills

Stop-Loss Claims

Process Governance

Documentation Strategy

Regulatory Awareness

Executive Communication

Cross-Functional Collaboration

Continuous Improvement

Tools

Visio

Miro

Knowledge Repositories

Job description

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

You will translate complex adjudication workflows into auditable, scalable operating models and partner with senior leaders to reduce variation and strengthen compliance. This role requires 3+ years in Stop-Loss Claims or complex claims operations, expertise in adjudication and regulatory considerations, and a proven ability to