Sr. Program Analyst, Federal Health

About the Role

At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient processes for program and patient health. We combine quality data-driven solutions, technology, and clinical expertise to create a more efficient path to quality care. This role will serve as a subject matter expert (SME) in VA disability benefits adjudication and federal program analysis, translating deep regulatory knowledge into structured business logic for AI model training and validation.

Responsibilities

• VA Disability Benefits Analysis – Primary Focus
  • Define and operationalize the regulatory and evidentiary definition of Ready for Decision (RFD) across targeted VA disability condition types, working backward to determine whether all legally and medically required evidence is present in the Veteran's e-folder.
  • Produce a condition-by-condition RFD Criteria Reference Guide mapping evidentiary requirements to 38 CFR Parts 3 and 4 and M21-1 adjudication standards.
  • Review and validate AI-generated determinations against the claim file or synthesized data; assess accuracy, reasoning quality, and correct identification of missing or incomplete development.
  • Review AI-compiled medical records and generated assessments for completeness and validity against applicable rating criteria, ensuring the AI accurately organizes evidence into a structured, human-readable format.
  • Translate VA rating knowledge into structured business logic suitable for AI model training and workflow validation; identify gaps between AI-expected claim interpretation and credentialed rater practice.
  • Maintain a running Edge Case Log documenting claim scenarios where AI determinations are incorrect or incomplete, with specific regulatory citations.
  • Provide ad hoc SME consultation on condition-specific standards, regulatory updates, and claims development pathways.
  • Coordinate with fellow SMEs to reach consensus positions before presenting findings to the program team and resolve conflicting analytical positions internally.
• Program Delivery Support
  • Participate in structured discovery sessions with Commence, technology partners, and federal agency stakeholders as the disability benefits regulatory expertise anchor.
  • Support user acceptance testing (UAT) and pilot readiness reviews; re-validate AI outputs following model updates or workflow changes.
  • Participate in federal agency stakeholder sessions as a credentialed SME when required.
  • Prepare written deliverables including analytical memos, criteria documentation, and structured feedback reports suitable for both technical and executive audiences.

Requirements

• Minimum 2 years of direct compensation claim rating experience as a VBA Rating Veteran Service Representative (RVSR). Requires broad familiarity across high-volume VA disability condition types and prior experience as a subject matter expert, trainer, or quality reviewer in a VA program context.
• Expert-level knowledge of 38 CFR Part 3 (Adjudication) and Part 4 (Schedule for Rating Disabilities); working knowledge of M21-1 adjudication procedures, including evidentiary sufficiency standards and Ready for Decision (RFD) criteria.
• Ability to assess the sufficiency of private medical records (PMR), service treatment records (STR), C&P exam reports, nexus opinions, buddy statements, VA Form 201 (personnel file), and other claim-relevant evidence in the e-folder to determine if the record is complete enough to render a rating decision without further development.
• Ability to translate complex regulatory knowledge into clear written deliverables (e.g., analytical memos, criteria documentation, structured feedback) for technology development teams and senior executive audiences.
• Ability to obtain and maintain a VA Public Trust clearance.

Qualifications

• Working knowledge of Social Security Administration program environments, disability determination workflows, and applicable legal and regulatory requirements is preferred.
• Existing SSA professional relationships and institutional knowledge that can inform Commence's expansion in the federal benefits space is a strong plus.

Work Environment

The work environment and physical demands described are representative of those required to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.

• This is an office/remote position.
• The employee regularly works in a climate-controlled environment.
• Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time.
• Occasionally required to stand, walk, use hands and fingers, kneel, or crouch.

Commence is open to remote candidates in the following states: AZ, AR, CO, DE, FL, GA, IL, IN, KS, KY, MA, MD, MI, MS, MO, MT, NC, NE, NV, NY, OH, OK, PA, SC, TN, TX, VA, DC, WI, and WV.