Stop-Loss Claims Process Architect

Sun Life; Milwaukee (WI); Hybrid; USD 40,000 - 91,000; Full time

Benefits offered by this job

Vacation & sick time

Paid family leave

401(k) match

Stock purchase options

Sabbatical program

Job summary

Sun Life U.S. is seeking a Process Consultant, Stop Loss Claims to drive governance, documentation strategy and continuous improvement across claims operations. You will partner with senior leaders to standardize workflows, align with regulatory requirements, and improve accuracy and resilience.

The role emphasizes cross-functional collaboration, audit readiness, and change leadership in a nationwide organization with strong benefits and career growth opportunities.

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 influence through insight rather than authority.
• Exceptional written and verbal communication skills, including executive-level materials.
• Experience partnering with audit, compliance, risk, or quality organizations.

Responsibilities

• Lead governance framework for 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 system capabilities.
• Serve as primary process SME during audits, regulatory reviews, and risk assessments.
• Provide guidance on process controls and remediation strategies.
• Lead cross-functional process evaluations to identify inefficiencies and variation.
• Design standardized, scalable process solutions to improve accuracy and throughput.
• Analyze audit findings and metrics to inform improvement roadmaps.
• Partner with IT, QA, Compliance, Legal, and Learning & Development.

Skills

Stop-Loss Claims

Process documentation

Audit & regulatory

Analytical thinking

Executive communication

Cross-functional collaboration

Change management

Education

Lean Six Sigma training

Tools

Visio

Miro

Enterprise knowledge repositories

Job description

Sun Life U.S. is seeking a Process Consultant, Stop Loss Claims to drive governance, documentation strategy and continuous improvement across claims operations. You will partner with senior leaders to standardize workflows, align with regulatory requirements, and improve accuracy and resilience.

The role emphasizes cross-functional collaboration, audit readiness, and change leadership in a nationwide organization with strong benefits and career growth opportunities.