Director, Clinical Operations

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.  

Job Description:

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Internal candidates are not required to relocate near an office.

The opportunity: The Director, Clinical Operations, is responsible for overseeing and managing the day-to-day operations of the Clinical team within Health and Risk Solutions. This role serves as a key link between strategic initiatives set by the AVP as well as our partners in Product Development and the tactical execution carried out by the Associate Directors and their teams. The Director will ensure the efficient and effective delivery of clinical review, clinical underwriting, and cost containment services, while also supporting the development and implementation of the Clinical 360 and Clinical 360+ programs.

How you will contribute: ​

• Oversee day-to-day operations of the Clinical Team, including Clinical Review, Underwriting, and Cost Containment (Clinical 360).
• Supervise and mentor the Associate Director, Clinical Services, and support team development and performance.
• Ensure timely and accurate completion of clinical reviews and consultations.
• Optimize workflows, processes, and standard operating procedures for efficiency.
• Lead implementation of strategic initiatives, including Clinical 360 program enhancements.
• Collaborate cross-functionally with Product, Client Success, Sales, and other departments.
• Monitor and report on team KPIs, project status, and operational performance.
• Oversee compliance with regulatory and internal policies and quality assurance standards.
• Contribute to budget planning and identify cost-saving opportunities without impacting quality.
• Leverage data analytics to support decision-making and continuous improvement.

What you will bring with you: 

• Ability to work with a diverse range of people
• Bachelor’s degree in nursing or related field; Master's degree preferred.
• 10+ years of experience in clinical operations, preferably in health insurance, group insurance, or stop-loss insurance.
• People management experience leading clinical teams.
• Strong understanding of medical underwriting claims review, and cost containment strategies.
• Excellent leadership, communication, and interpersonal skills.
• Proven ability to manage complex projects and drive results.
• Strong analytical and problem-solving skills.
• Experience with healthcare analytics and reporting tools.
• Ability to thrive in a fast-paced, dynamic environment and manage multiple priorities.

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.