AVP, 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.

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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 Assistant Vice President (AVP) of Claims is responsible for providing strategic leadership and managing all activities across the entire Stop Loss claims lifecycle. This role ensures compliance, identifies opportunities for continuous improvement, and delivers top-tier operational results to support the profitable growth of our Health & Risk Solutions (H&RS) businesses. The position involves developing and executing strategic initiatives that align with our focus on improving access, managing risk and driving better health outcomes. As a key leader within H&RS, the AVP will have significant external-facing responsibilities and will coordinate with various internal functions including underwriting, distribution, client success, contract issuance, legal and compliance, product development, IT, actuarial, and risk management.

How you will contribute:

• Provide strategic leadership to the Health and Risk Solutions (HRS) Stop Loss Claims team, aligning initiatives with broader company goals.
• Drive operational excellence by advancing claims processes, implementing automation, and enhancing service tools and analytics.
• Leverage advanced analytics, AI, and automation to enhance operational efficiency
• Foster cross-functional partnerships across underwriting, legal, finance, distribution, and IT to ensure seamless claim operations and support business objectives.
• Champion digital transformation and data-driven decision-making to improve claim outcomes and efficiency.
• Cultivate best-in-class claims capabilities, strengthening Sun Life’s position as a market leader in Stop Loss claims.
• Lead initiatives that advance margin improvement and cost management across claims operations.
• Support strategic planning and execution of new business initiatives and product development. Provide strategic input on the Clinical 360 program and Health Capabilities.

What you will bring with you:

• Ability to work with a diverse range of people
• 10+ years relevant expertise and experience, 5+ years in a leadership role
• 5+ years of Health Insurance, Group Insurance or Stop Loss Insurance experience (preferred)
• Bachelor's degree required
• Stop Loss or health care industry expert with demonstrated experience managing significant organizational change initiatives
• A deep understanding of the U.S. healthcare delivery system and best practices regarding care and cost management programs
• A working understanding of the many functions required for successful partnership with internal parties, including underwriting, distribution, TPA strategy, and legal and compliance
• Experience with risk based and/or clinical products and services preferred
• Experience overseeing a claims management function
• Excellent leadership skills with a demonstrated ability to build trust, recognize and develop talent, and coach direct reports and others

Salary:

$153,900-$246,200

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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