Process Consultant, Stop Loss Claims
Core
Process governance, end-to-end documentation strategy, and continuous improvement for Stop Loss Claims Operations to ensure quality, compliance, scalability, and risk management.
Role type
Senior Process Consultant (Claims Operations)
Builds
Standardized, auditable, and future-ready operating models for Stop Loss Claims
Domain
Insurance (Stop Loss Claims) + Process Engineering
Required skills
Stop-loss adjudication expertise, enterprise-level process documentation design, cross-functional process improvement, audit and regulatory compliance knowledge, change management, systems thinking, analytical problem-solving
Preferred skills
AI-enabled solutions knowledge (intelligent document processing, workflow automation), process mapping tools (Visio, Miro), Lean/Six Sigma training, large-scale operational readiness experience
Technologies
Visio, Miro, enterprise knowledge repositories, intelligent document processing, workflow automation, predictive analytics
Responsibilities
Support end-to-end governance framework for Stop-Loss Claims processes and SOPs; Lead complex cross-functional process evaluations to identify inefficiencies; Act as liaison across Claims, QA, Compliance, Audit, Legal, and IT; Lead change planning and communication for multi-stakeholder initiatives; Support linkage between process design, quality outcomes, and regulatory compliance; Proactively identify process-driven risk and recommend mitigation strategies
Seniority
Senior, hands-on IC