Director, Stop Loss Claims

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.  

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work.  Our team members and leaders are expected to foster connection and teamwork by being present in the office at least 2 days per week.

 

Director, Stop Loss Claims

Responsible for our multi-site claims organization, providing strategic leadership and managing all activities across the entire Stop Loss claims lifecycle.  This role focuses on improving efficiencies, enhancing client experience, and streamlining claims adjudication processes for our Stop Loss product line. This role requires a strategic thinker with extensive knowledge of Stop Loss claims, strong leadership skills, and project management expertise. Additionally, this position is responsible for maximum level of Client service which has a direct impact on meeting persistency targets. This role offers an opportunity to drive significant improvements in our claims operations while ensuring top-tier client service in the Stop Loss insurance sector.

How you will contribute:

·         Drive operational excellence by advancing claims processes and implementing automation

·         Manage and optimize claims operations across multiple sites

·         Monitor and manage inventory to meet defined metrics and OKR’s

·         Collaborate effectively across multiple departments to achieve goals

·         Identify opportunities and implement solutions for improved CX based on feedback and needs expressed by clients and brokers

·         Cultivate best-in-class claims capabilities, strengthening Sun Life’s position as a market leader in Stop Loss Claims

·         Identify and implement process improvements to enhance efficiency and reduce staffing

·         Manage claims staff, including selection, training, and performance oversight

·         Ensure compliance with internal audit requirements and regulatory standards

·         Resolve escalated customer issues and maintain high levels of client service

·         Lead projects to improve claims processing and customer experience

·         Analyze claims trends and provide insights for product development and reporting

·         Develop and implement strategies to meet quality and turnaround time goals

What you will bring with you:

·         Ability to work with a diverse range of people

·         Bachelor's degree or equivalent experience

·         7+ years of Stop Loss and/or Medical claims and product knowledge

·         5+ years in a leadership role

·         Extensive understanding of Stop Loss/Medical products, claims systems, and service impacts

·         Experience overseeing a claims management function

·         Strong leadership, coaching, and team-building skills

·         Excellent communication and interpersonal abilities

·         Proficiency in MS Office and claims-related software

·         Experience in project management and process improvement methodologies

·         Superior collaboration skills

·         Demonstrates resilience by reacting positively to changes and maintains poise, focus and flexibility when encountering difficulties or obstacles

·         Ability to interpret and communicate policy language effectively

Salary $129,200 - $193,800

At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.

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We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive.  We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate.  We encourage applications from qualified individuals from all backgrounds.

Life is brighter when you work at Sun Life

At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program.  Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account.  Enjoy a flexible, inclusive and collaborative work environment that supports career growth.  We’re proud to be recognized in our communities as a top employer.  Proudly Great Place to Work® Certified in Canada and the U.S., we’ve also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row.  Visit our website to learn more about our benefits and recognition within our communities.

We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email thebrightside@sunlife.com to request an accommodation.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

We do not require or administer lie detector tests as a condition of employment or continued employment.

Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Claims - Health & Dental

21/05/2026