Stop-Loss Claims Process Excellence Specialist

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

Job summary

Sun Life U.S. is seeking a Process Consultant, Stop Loss Claims to oversee governance, documentation strategy, and continuous improvement across Stop-Loss Claims Operations.

You’ll partner with senior leaders across Claims, Compliance, Quality, Audit, IT, and Learning to reduce variation and drive measurable outcomes. This role requires a seasoned claims professional who can influence beyond authority and design future-ready processes.

Qualifications

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

Responsibilities

• Support end-to-end governance for Stop-Loss Claims processes, SOPs, templates, and workflows with audit-ready documentation.
• Lead cross-functional process evaluations to identify inefficiencies and gaps and design standardized solutions.
• Partner with Claims Ops, QA, Compliance, Audit, Legal, IT, and Learning to align processes with strategy and risk controls.
• Lead change planning and adoption strategies to ensure smooth implementation of new processes.

Skills

Stop-Loss Claims

Process governance

Regulatory compliance

Audits

Process improvement

Communication

Lean Six Sigma

Visio

Miro

Tools

Visio

Miro

Job description

Sun Life U.S. is seeking a Process Consultant, Stop Loss Claims to oversee governance, documentation strategy, and continuous improvement across Stop-Loss Claims Operations.

You’ll partner with senior leaders across Claims, Compliance, Quality, Audit, IT, and Learning to reduce variation and drive measurable outcomes. This role requires a seasoned claims professional who can influence beyond authority and design future-ready processes.