Stop-Loss Claims Process Architect

Sustainable World, Inc.; Wellesley, Northern (MA, KY); Hybrid; USD 60,000 - 91,000; Full time

Benefits offered by this job

Vacation & sick time

Medical coverage

401(k) with match

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 translates complex adjudication workflows into auditable, standardized operating models and partners with senior leaders across Claims, Compliance, QA, Audit, IT, and Learning to reduce variation and drive measurable outcomes.

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.

Responsibilities

• Provide governance for end-to-end Stop-Loss Claims processes, SOPs, templates, and workflows.
• Design standardized, scalable process solutions to improve accuracy and throughput.
• Lead cross-functional process evaluations to identify inefficiencies and risk.
• Partner with Claims Ops, QA, Compliance, Audit, Legal, IT, and Learning to drive improvements.
• Lead change management and adoption strategies with clear accountability.

Skills

Stop-Loss Claims

Regulatory considerations

Process documentation

Analytical skills

Executive communication

Tools

Visio

Miro

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 translates complex adjudication workflows into auditable, standardized operating models and partners with senior leaders across Claims, Compliance, QA, Audit, IT, and Learning to reduce variation and drive measurable outcomes.