Stop-Loss Claims Process Architect

Sun Life Financial; 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, documentation strategy and continuous improvement across Stop-Loss Claims Operations.

You will translate complex adjudication workflows into auditable operating models, partnering with Claims, Compliance, QA, Audit, IT and Learning to reduce variation and raise quality. The role requires 3+ years in Stop-Loss Claims, strong analytical skills, and the ability to influence without authority.

Qualifications

• 3+ years of progressive experience in Stop-Loss Claims or complex claims operations.
• Expertise in stop-loss adjudication and regulatory considerations.
• Proven ability to design, govern, and sustain enterprise-level process documentation.
• Strong analytical and communication skills, with executive-level materials.

Responsibilities

• Lead end-to-end governance for Stop-Loss Claims processes, SOPs, templates, and workflows.
• Design standardized, scalable process solutions to improve accuracy and throughput.
• Analyze audit findings and metrics to inform improvement roadmaps.
• Collaborate with Claims, Compliance, Audit, Legal, IT, and Learning to enable readiness.
• Drive change leadership and adoption with clear risks and success measures.

Skills

Stop-Loss Claims

Process Governance

Documentation Strategy

Stakeholder Management

Regulatory Awareness

Tools

Visio

Miro

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 Stop-Loss Claims Operations.

You will translate complex adjudication workflows into auditable operating models, partnering with Claims, Compliance, QA, Audit, IT and Learning to reduce variation and raise quality. The role requires 3+ years in Stop-Loss Claims, strong analytical skills, and the ability to influence without authority.