Process Consultant, Stop Loss Claims

Sun Life

Process Consultant governing stop-loss claims documentation, controls, and improvement. Supporting Sun Life’s employee and government benefits operations through compliant, scalable claims processes.

Posted 8/20/2026full-timeWellesley Hills • Connecticut, Maine, Maryland, Massachusetts, Montana • 🇺🇸 United StatesMid-LevelSenior💰 $60,400 - $90,600 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Stop-Loss Claims processes, operational workflows, and regulatory compliance, with a strong focus on process documentation and improvement. Proven ability to lead cross-functional initiatives and drive change management strategies effectively.

Highest-signal resume keywords

Stop-Loss AdjudicationProcess Documentation GovernanceCross-Functional Process ImprovementChange ManagementLean Six Sigma Training

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Process MappingOperational WorkflowsRegulatory ComplianceAnalytical SkillsProblem-Solving Skills

Soft Skills

Written CommunicationVerbal CommunicationCoaching Skills

Tools & Technologies

VisioMiroIntelligent Document ProcessingWorkflow AutomationPredictive Analytics

Certifications & Qualifications

Lean Six Sigma Certification

Industry Keywords

Stop-Loss ClaimsClaims OperationsAuditComplianceRisk Management

About the role

Key responsibilities & impact

Support the end-to-end governance framework for Stop-Loss Claims processes, SOPs, templates, and workflows
Establish standards for documentation quality, structure, version control, approval, and lifecycle management
Ensure documentation remains audit-ready and aligned with regulatory requirements, system capabilities, and business strategy
Serve as a primary process SME during internal and external audits, regulatory reviews, and risk assessments
Advise leaders on process controls, documentation risk, and remediation strategies
Lead cross-functional process evaluations to identify inefficiencies, control gaps, and variation
Design and implement standardized, scalable process solutions to improve accuracy, throughput, and operational resilience
Analyze audit findings, QA trends, operational metrics, and error patterns to inform improvement roadmaps
Liaise across Claims Operations, QA, Compliance, Audit, Legal, IT, and Learning & Development
Define business requirements, document future-state workflows, and ensure operational readiness for system and technology initiatives
Partner with Learning & Development on training strategy and materials
Lead change planning, communication, adoption strategies, and implementation guidance
Coach leaders and teams through change and ensure adoption of revised processes
Identify process-driven risks and recommend mitigation strategies
Drive corrective and preventive actions through procedure, control, and guidance updates
Strengthen the Claims control environment through clarity, consistency, and accountability

Requirements

What you’ll need

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
Exceptional written and verbal communication skills, including executive-level materials
Demonstrated experience with cross-functional process improvement or transformation initiatives
Experience partnering with audit, compliance, risk, or quality organizations
Knowledge of emerging technologies and AI-enabled solutions, including intelligent document processing, workflow automation, and predictive analytics
Familiarity with process mapping and documentation platforms such as Visio, Miro, and enterprise knowledge repositories
Lean, Six Sigma, or comparable continuous improvement training
Experience supporting large-scale change management or operational readiness efforts

Benefits

Comp & perks

Generous vacation and sick time
Market-leading paid family, parental and adoption leave
Medical coverage
Company paid life and AD&D insurance
Disability programs
Partially paid sabbatical program
401(k) employer match
Stock purchase options
Employer-funded retirement account
Flexible, inclusive and collaborative work environment
Career growth support
Reasonable accommodations for qualified individuals with disabilities and special disabled veterans