Stop-Loss Claims Process Consultant: Governance & Optimization

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

Job summary

Sun Life U.S. is a leading provider of employee and government benefits, delivering comprehensive coverage across the country and partnering with employers and plans to help Americans access care and security.

The Process Consultant, Stop Loss Claims, will own governance, end-to-end documentation strategy, and continuous improvement within Stop Loss Claims Operations, partnering with Claims, Compliance, Audit, IT and Learning to elevate quality and risk management.

Qualifications

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

Responsibilities

• Govern end-to-end Stop-Loss Claims processes, SOPs, templates, and workflows.
• Develop standards for documentation quality, structure, version control, approval, and lifecycle.
• Ensure documentation remains 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 and remediation strategies.
• Lead cross-functional evaluations to identify inefficiencies and gaps affecting quality and cost.
• Design standardized, scalable process solutions to improve accuracy and throughput.
• Analyze audit findings, QA trends, metrics, and error patterns to inform roadmaps.
• Partner with Learning & Development to reflect processes in training materials.

Skills

Stop-Loss Claims

Process Governance

Documentation Strategy

Audit & Compliance

Cross-functional Collaboration

Analytical Thinking

Executive Communication

Tools

Visio

Miro

Enterprise Knowledge Repositories

Job description

Sun Life U.S. is a leading provider of employee and government benefits, delivering comprehensive coverage across the country and partnering with employers and plans to help Americans access care and security.

The Process Consultant, Stop Loss Claims, will own governance, end-to-end documentation strategy, and continuous improvement within Stop Loss Claims Operations, partnering with Claims, Compliance, Audit, IT and Learning to elevate quality and risk management.