Stop-Loss Claims Process Architect

Sustainable World, Inc.; Portland (OR); On-site; USD 60,000 - 91,000; Full time

Benefits offered by this job

401(k) employer match

Stock purchase options

Employer-funded retirement account

Job summary

Sun Life U.S. is seeking a Process Consultant, Stop-Loss Claims to govern end-to-end processes, standards, and documentation across the stop-loss function. You will partner with senior leaders to reduce variation, drive measurable improvements, and ensure compliance.

The role requires experience in stop-loss claims, strong communication, and the ability to influence beyond authority. You will design standardized workflows, support audits, and lead change with a focus on quality and risk

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 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.

Responsibilities

• 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 to leaders on process controls, documentation risk, and remediation strategies.
• Lead cross-functional process evaluations to identify inefficiencies and variation affecting quality or cost.
• Design standardized, scalable process solutions to improve accuracy, throughput, and resilience.
• Analyze audit findings, QA trends, and metrics to inform roadmaps.
• Apply continuous improvement methodologies to upstream and downstream processes.
• Partner with Claims Operations, QA, Compliance, Audit, Legal, IT, and Learning & Development.

Skills

Stop-Loss Claims

Process Governance

Change management

Executive communication

Cross-functional collaboration

Data analysis

Regulatory awareness

Problem solving

Influence without authority

Process documentation

Risk management

AI/automation awareness

Tools

Visio

Miro

Enterprise knowledge repositories

Job description

Sun Life U.S. is seeking a Process Consultant, Stop-Loss Claims to govern end-to-end processes, standards, and documentation across the stop-loss function. You will partner with senior leaders to reduce variation, drive measurable improvements, and ensure compliance.

The role requires experience in stop-loss claims, strong communication, and the ability to influence beyond authority. You will design standardized workflows, support audits, and lead change with a focus on quality and risk