Process Consultant, Stop Loss Claims

• 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

• 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

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.

• Stop-Loss Adjudication
• Process Documentation Governance
• Cross-Functional Process Improvement
• Change Management
• Lean Six Sigma Training

• Process Mapping
• Operational Workflows
• Regulatory Compliance
• Analytical Skills
• Problem-Solving Skills

• Written Communication
• Verbal Communication
• Coaching Skills

• Lean Six Sigma Certification

• Stop-Loss Claims
• Claims Operations
• Audit
• Compliance
• Risk Management

• Visio
• Miro
• Intelligent Document Processing
• Workflow Automation
• Predictive Analytics