Stop-Loss Claims Process Architect

Sun Life; Hartford (CT); On-site; USD 60,000 - 91,000; Full time

Benefits offered by this job

Vacation and sick time

Family leave

401(k) match

Stock purchase options

Job summary

Sun Life U.S. is a leading provider of employee and government benefits with a nationwide footprint and a focus on helping clients achieve financial security.

The Process Consultant, Stop Loss Claims will drive governance, documentation standards, and process improvements across Stop-Loss Claims operations while collaborating with senior leaders in Claims, Compliance, Quality, Audit, IT, and Learning. The role emphasizes reducing variation, ensuring audit readiness, and guiding system and

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 emerging technologies and AI-enabled solutions for processes.

Responsibilities

• Govern end-to-end Stop-Loss Claims processes, SOPs, templates, and workflows.
• Establish standards for documentation quality, structure, version control, approval, and lifecycle management.
• Ensure documentation is audit-ready and aligns with regulatory requirements and business strategy.
• Serve as primary process SME during audits, regulatory reviews, and risk assessments.
• Provide guidance on process controls, risks, and remediation strategies.
• Lead cross-functional evaluations to identify inefficiencies and variation impacting quality or cost.
• Design standardized, scalable process solutions to improve accuracy and throughput.
• Analyze audit findings and metrics to inform improvement roadmaps.
• Apply continuous improvement to strengthen upstream and downstream processes.
• Partner with Claims Operations, QA, Compliance, Audit, Legal, IT, and Learning & Development.

Skills

Stop-Loss Claims

Job description

Sun Life U.S. is a leading provider of employee and government benefits with a nationwide footprint and a focus on helping clients achieve financial security.

The Process Consultant, Stop Loss Claims will drive governance, documentation standards, and process improvements across Stop-Loss Claims operations while collaborating with senior leaders in Claims, Compliance, Quality, Audit, IT, and Learning. The role emphasizes reducing variation, ensuring audit readiness, and guiding system and