Job Summary

The Subject Matter Expert (SME) will provide specialized operational, technical, and business expertise supporting the Veterans Health Administration (VHA) Integrated Veteran Care (IVC) Veteran Family Member Programs (VFMP) Modernization Portfolio. This position supports enterprise modernization initiatives involving healthcare claims processing, eligibility modernization, appeals modernization, Electronic Data Interchange (EDI), workflow automation, intake modernization, operational transformation, and systems integration.

 

The SME will serve as a trusted advisor and functional expert supporting modernization projects across VFMP operational areas including intake, claims adjudication, appeals processing, eligibility determination, benefits coordination, pharmacy operations, care coordination, duty to assist, nursing review, and customer service functions. The SME will support analysis, solution development, operational process optimization, implementation planning, testing, stakeholder coordination, and modernization adoption activities.

 

This role requires strong subject matter expertise in healthcare operations, modernization initiatives, operational workflows, systems implementation, and business process improvement. The SME will collaborate closely with Government stakeholders, project managers, analysts, developers, architects, operational leadership, and contractor teams to ensure modernization solutions align with operational objectives, compliance requirements, and organizational priorities.

 

The SME will provide guidance and recommendations supporting strategic modernization efforts that improve operational efficiency, reduce processing backlogs, enhance customer experience, and support long-term sustainability of VFMP operations.

Primary Responsibilities

Subject Matter Expertise & Operational Support

• Provide specialized operational and functional expertise supporting VFMP modernization initiatives.
• Advise project teams and stakeholders on healthcare operations, workflow impacts, and modernization strategies.
• Support modernization initiatives involving:
• Claims processing
• Eligibility modernization
• Appeals modernization
• Intake automation
• EDI implementation
• Care coordination
• Benefits coordination
• Pharmacy support
• Duty to assist operations
• Nursing review workflows
• Analyze operational challenges and recommend process improvement solutions.
• Assist with development of modernization strategies supporting operational efficiency and backlog reduction.

Business Process Analysis & Improvement

• Analyze current-state and future-state operational workflows and business processes.
• Identify operational gaps, inefficiencies, and opportunities for automation and modernization.
• Support development of business process redesign initiatives and workflow optimization strategies.
• Assist with operational assessments and process mapping activities.
• Recommend operational improvements aligned with VFMP modernization objectives.
• Support integration of modernization solutions into operational workflows and business processes.

Requirements Development & Solution Support

• Participate in requirements gathering sessions with operational and technical stakeholders.
• Support development and validation of:
• Business Requirements Documents (BRDs)
• User Stories
• Process Flow Diagrams
• Operational Workflows
• Requirements Traceability Matrices (RTMs)
• Standard Operating Procedures (SOPs)
• Operational Readiness Assessments
• Assist technical teams in translating operational requirements into system and workflow solutions.
• Ensure modernization solutions align with operational needs and compliance requirements.

Testing, Validation & Implementation Support

• Support User Acceptance Testing (UAT), end-to-end testing, and operational validation activities.
• Develop and review test cases, test scenarios, and business validation criteria.
• Assist with defect identification, issue resolution, and operational troubleshooting activities.
• Participate in implementation planning, deployment readiness, and post-implementation support activities.
• Validate operational functionality and workflow performance during implementation efforts.

Minimum Qualifications

Education

Bachelor’s degree in:

• Healthcare Administration
• Business Administration
• Public Administration
• Health Informatics
• Information Systems
• Organizational Leadership
• Or related field

Equivalent professional experience may be considered where appropriate.

 

Required Experience

• Minimum five (5) years of specialized operational, business, or technical experience supporting healthcare operations, modernization initiatives, systems implementation, or operational transformation efforts.
• Experience supporting operational process improvement and workflow optimization initiatives.
• Experience participating in systems modernization, implementation, or enterprise transformation projects.
• Experience supporting stakeholder coordination and cross-functional collaboration activities.
• Experience developing or reviewing operational documentation, workflows, requirements, or implementation materials.

Desired Qualifications

• Previous experience supporting Department of Veterans Affairs (VA) or Veterans Health Administration (VHA) programs.
• Experience supporting healthcare claims processing, eligibility operations, appeals modernization, or EDI initiatives.
• Experience supporting Federal healthcare modernization or operational transformation initiatives.
• Experience supporting workflow automation, intake modernization, or Robotic Process Automation (RPA) initiatives.
• Familiarity with Agile, hybrid, or enterprise implementation methodologies preferred.