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, and scalability.
Role type
Senior Process Consultant (Claims Operations)
Builds
Standardized, auditable operating models for stop-loss claims adjudication and workflows.
Domain
Insurance / Healthcare Claims / Process Optimization
Required skills
Stop-loss claims adjudication expertise, enterprise-level process documentation design, cross-functional process improvement, audit and compliance liaison, change management, systems thinking, analytical problem-solving, executive communication, knowledge of AI-enabled solutions (IDP, workflow automation), process mapping tools (Visio, Miro), Lean/Six Sigma.
Preferred skills
Experience with intelligent document processing, predictive analytics, large-scale operational readiness efforts.
Responsibilities
Establish standards for documentation quality, structure, and lifecycle management; lead cross-functional process evaluations to identify inefficiencies; act as a liaison across Claims, QA, Compliance, Audit, Legal, and IT; lead change planning and communication for multi-stakeholder initiatives; support system initiatives by defining business requirements and documenting future-state workflows; proactively identify process-driven risks and recommend mitigation strategies.
Seniority
Senior, hands-on IC