Subject Matter Expert

Primary Responsibilities

• Provide specialized operational and functional expertise supporting VFMP modernization initiatives.
• Advise project teams and stakeholders on healthcare operations, workflow impacts, and modernization strategies.
• 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.
• Support analysis, solution development, operational process optimization, implementation planning, testing, stakeholder coordination, and modernization adoption activities.

Requirements

• 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), and Standard Operating Procedures (SOPs).
• Affirmatively support operational assessments and process mapping activities.
• Assist technical teams in translating operational requirements into system and workflow solutions.
• Ensure modernization solutions align with operational needs and compliance requirements.
• Support integration of modernization solutions into operational workflows and business processes.

Qualifications

• 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.