Stop-Loss Claims Process Excellence Lead

Sun Life; Wellesley (MA); On-site; USD 60,000 - 91,000; Full time

Benefits offered by this job

Generous vacation and sick time

401(k) employer match

Stock purchase options

Job summary

Sun Life U.S. invites a Process Consultant, Stop Loss Claims, to join our Claims Operations team.

You will translate complex adjudication workflows into standardized, auditable operating models and partner with senior leaders across Claims, Compliance, Audit, IT, and Learning to reduce variation and drive measurable outcomes. The role requires 3+ years in Stop-Loss Claims or complex claims operations, expertise in adjudication and regulatory considerations, and a track record in process

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 influence through insight.
• Exceptional written and verbal communication skills, including executive materials.
• Experience with cross-functional process improvement or transformation initiatives.
• Experience partnering with audit, compliance, risk, or quality organizations.
• Knowledge of AI-enabled solutions for process enhancement (e.g., intelligent document processing).
• Familiarity with Visio, Miro, and enterprise knowledge repositories.
• Lean, Six Sigma, or comparable continuous improvement training.
• Experience supporting large-scale change management or operational readiness efforts.

Responsibilities

• Govern Stop-Loss Claims processes with an end-to-end documentation strategy and audit readiness.
• Lead complex, cross-functional process evaluations to identify inefficiencies and gaps.
• Design standardized, scalable process solutions to improve accuracy and throughput.
• Act as a liaison across Claims Operations, QA, Compliance, Audit, Legal, IT, and Learning.
• Lead change planning and adoption guidance for multi-stakeholder initiatives.
• Strengthen the control environment by updating procedures, controls, and guidance.

Skills

Stop-Loss claims

Stop-Loss adjudication

Regulatory knowledge

Process documentation

Analytical thinking

Communication skills

Process improvement

Audit collaboration

AI in processes

Visio

Miro

Knowledge repositories

Lean Six Sigma

Change management

Tools

Visio

Miro

Knowledge repositories

Job description

Sun Life U.S. invites a Process Consultant, Stop Loss Claims, to join our Claims Operations team.

You will translate complex adjudication workflows into standardized, auditable operating models and partner with senior leaders across Claims, Compliance, Audit, IT, and Learning to reduce variation and drive measurable outcomes. The role requires 3+ years in Stop-Loss Claims or complex claims operations, expertise in adjudication and regulatory considerations, and a track record in process