Stop-Loss Claims Process Architect

Sun Life; United States; On-site; USD 60,000 - 91,000; Full time

Job summary

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

The role partners with senior leaders across Claims, Compliance, Quality, Audit, IT and Learning to reduce variation, strengthen risk management, and deliver auditable, scalable processes that support regulatory readiness and better member experience.

Qualifications

• 3+ years of progressive experience in Stop-Loss Claims or complex claims operations.
• Expertise in stop-loss adjudication and operational workflows.
• Proven ability to design, govern, and sustain enterprise-level process documentation.
• Strong analytical and communication skills, including executive-level materials.
• Experience partnering with audit, compliance, risk, or quality organizations.

Responsibilities

• Provide process governance for Stop-Loss Claims processes, SOPs, templates, and workflows.
• Establish standards for documentation quality, structure, and lifecycle management.
• Lead cross-functional evaluations to identify inefficiencies and variation.
• Design standardized, scalable process solutions to improve accuracy and throughput.
• Collaborate with Claims, Compliance, Audit, IT, and Learning to ensure readiness.

Skills

Stop-Loss Claims

Process Governance

Documentation Strategy

Audits & Compliance

Change Leadership

Tools

Visio

Miro

Enterprise knowledge repositories

Job description

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

The role partners with senior leaders across Claims, Compliance, Quality, Audit, IT and Learning to reduce variation, strengthen risk management, and deliver auditable, scalable processes that support regulatory readiness and better member experience.