Stop-Loss Claims Process Architect

Sun Life Financial; Wellesley, Northern (MA, KY); Hybrid; USD 54,000 - 91,000; Full time

Job summary

Sun Life U.S. is actively seeking a Process Consultant to govern Stop-Loss Claims processes, develop end-to-end documentation, and drive continuous improvement.

You will partner with senior leaders across Claims, Compliance, QA, Audit, IT, and Learning to reduce risk and elevate process quality. This role suits an experienced claims professional who can influence beyond authority while maintaining audit-readiness.

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 written and verbal communication with executive stakeholders.
• Experience partnering with audit, compliance, risk, or quality teams.

Responsibilities

• Lead end-to-end governance for Stop-Loss Claims processes and SOPs.
• Design standardized, scalable process solutions to improve accuracy and throughput.
• Collaborate with Claims, Compliance, IT, Audit, Legal, Learning & Development.
• Drive change leadership and training readiness for new processes.

Skills

Stop-Loss claims expertise

Process governance

Documentation & SOPs

Stakeholder influence

Analytical problem-solving

Executive communication

Change management

Education

Lean Six Sigma training

Tools

Visio

Miro

Enterprise knowledge repositories

Job description

Sun Life U.S. is actively seeking a Process Consultant to govern Stop-Loss Claims processes, develop end-to-end documentation, and drive continuous improvement.

You will partner with senior leaders across Claims, Compliance, QA, Audit, IT, and Learning to reduce risk and elevate process quality. This role suits an experienced claims professional who can influence beyond authority while maintaining audit-readiness.