Process Consultant, Stop Loss Claims

Sun Life • Nashville, TN

10d • $60,400 - $90,600

About The Position

The Process Consultant, Stop Loss Claims is accountable for process governance, end-to-end documentation strategy, and continuous improvement within Stop Loss Claims Operations. The role strengthens quality, compliance, scalability, and risk management by translating complex claims adjudication and system workflows into standardized, auditable, future-ready operating models. It partners with senior leaders and teams across Claims, Compliance, Quality, Audit, IT, Legal, and Learning to reduce variation, enable change, and improve operational outcomes. The position is suited to an experienced claims professional who can influence beyond direct authority, anticipate downstream risk, and elevate the organization through disciplined process design and governance.

Requirements

• At least 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 preparation of executive-level materials.
• Demonstrated experience with cross-functional process improvement or transformation initiatives.
• Experience partnering with audit, compliance, risk, or quality organizations.

Nice To Haves

• Knowledge of how emerging technologies and AI-enabled solutions, such as intelligent document processing, workflow automation, and predictive analytics, can enhance business processes.
• 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.

Responsibilities

• 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 evolving business strategy.
• Serve as a primary process subject matter expert during internal and external audits, regulatory reviews, and risk assessments.
• Advise leaders on process controls, documentation risk, and remediation strategies.
• Lead complex, cross-functional process evaluations to identify inefficiencies, control gaps, and variation affecting quality, cost, or member experience.
• Design and implement standardized, scalable process solutions to improve accuracy, throughput, and operational resilience.
• Analyze audit findings, quality assurance trends, operational metrics, and error patterns to inform improvement roadmaps.
• Apply systems thinking and continuous improvement methodologies to strengthen upstream and downstream processes.
• Act as a liaison across Claims Operations, QA, Compliance, Audit, Legal, IT, and Learning & Development.
• Influence decisions by articulating risks, impacts, and trade-offs related to process or system changes.
• Support system and technology initiatives by defining business requirements, documenting future-state workflows, and ensuring operational readiness.
• Partner with Learning & Development to ensure training strategy and materials accurately reflect approved processes and controls.
• Lead change planning and communication for complex, multi-stakeholder process initiatives.
• Develop adoption strategies and implementation guidance.
• Coach leaders and teams through change by clarifying expectations, risks, and success measures.
• Ensure adoption of new or revised processes with minimal disruption to operations.
• Support the connection between process design, quality outcomes, and regulatory compliance.
• Identify process-driven risks and recommend mitigation strategies aligned with enterprise risk frameworks.
• Drive corrective and preventive actions through updates to procedures, controls, and guidance.
• Strengthen the Claims control environment through clarity, consistency, and accountability.

Benefits

• Generous vacation and sick time
• 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 supporting career growth
• Discretionary annual incentive award based on individual and business performance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed