Stop-Loss Claims Process Architect

Sustainable World, Inc.; Kansas City (MO); Hybrid; USD 60,000 - 91,000; Full time

Benefits offered by this job

401(k) match

Medical coverage

Vacation & sick time

Life and AD&D insurance

Job summary

Sun Life U.S. is leading benefits provider with nationwide reach. The Process Consultant, Stop Loss Claims will governance end-to-end processes, standardize documentation, and drive improvements across Claims Operations.

You’ll partner with senior leaders to reduce variation, ensure audit readiness, and strengthen risk management in a complex, regulated environment. This role demands expertise in stop-loss adjudication, cross-functional collaboration, and the ability to influence beyond formal

Qualifications

• 3+ years in Stop-Loss Claims or complex claims operations.
• Expertise in stop-loss adjudication and regulatory considerations.
• Design, govern, and sustain enterprise-level process documentation.
• Strong analytical and problem-solving skills; influence outcomes through insight.
• Excellent written and verbal communication, including executive materials.
• Experience with cross-functional process improvement initiatives.
• Experience partnering with audit, compliance, risk, or quality groups.
• Knowledge of AI-enabled solutions in business processes.
• Familiarity with process mapping and documentation platforms.
• Lean, Six Sigma or comparable continuous improvement training.
• Experience supporting large-scale change management or operational readiness.

Responsibilities

• Lead governance framework for Stop-Loss Claims processes, SOPs, templates, and workflows.
• Establish standards for documentation quality, structure, lifecycle management.
• Ensure documentation is audit-ready and compliant with regs and systems.
• Serve as primary process SME during audits, regulatory reviews, and risk assessments.
• Provide guidance on process controls and remediation strategies.
• Lead cross-functional evaluations to identify inefficiencies and gaps.
• Design standardized, scalable process solutions to improve throughput.
• Analyze audit findings, QA trends, metrics, and error patterns for roadmaps.
• Apply continuous improvement to upstream and downstream processes.
• Partner with Claims Ops, QA, Compliance, IT, Learning & Development.

Skills

Stop-Loss Claims

Process documentation

Cross-functional

Executive comms

Analytical skills

AI solutions

Process mapping

Lean Six Sigma

Change management

Tools

Visio

Miro

Knowledge repos

Job description

Sun Life U.S. is leading benefits provider with nationwide reach. The Process Consultant, Stop Loss Claims will governance end-to-end processes, standardize documentation, and drive improvements across Claims Operations.

You’ll partner with senior leaders to reduce variation, ensure audit readiness, and strengthen risk management in a complex, regulated environment. This role demands expertise in stop-loss adjudication, cross-functional collaboration, and the ability to influence beyond formal