New

Subject Matter Expert (SME) - VHA Health Claims Processing

Trilogy Federal
vision insurance, parental leave, paid time off, paid holidays, tuition reimbursement, 401(k)
United States, D.C., Washington
810 Vermont Avenue Northwest (Show on map)
Sep 30, 2025
Trilogy Federal drives innovative solutions for complex business challenges across financial management, healthcare, and government industries. Our collaborative, client-first service approach, combined with our commitment to the rapid implementation of pragmatic solutions, has earned Trilogy an unparalleled reputation for delivering transformative results. Trilogy Federal is seeking a highly skilled and motivated Subject Matter Expert (SME) to join our team for a new remote role. The chosen candidate must have extensive experience and knowledge of VHA Claims Processing systems. Experience with the family member program is highly desirable. This role requires expertise in claims processing systems and understanding various historical functionalities and mapping new capabilities across systems. The ideal candidate will have strong problem-solving skills, experience in systems development methodologies, and a proven track record of working on complex projects. This person will coordinate with program stakeholders and serve as a primary liaison between business operations and technical development teams. This position may require occasional travel in support of client needs and expectations. Primary Responsibilities: Collaborate with cross-functional teams to define requirements and understand the underlying model. Document current system capabilities, to ensure they are addressed in sunsetting effort of current Claims Processing &Eligibility (CP&E) system. Investigate and gather necessary information to determine current capabilities are captured in new system functionalities and requirements. Meet and work with project business sponsors, software end-users, applications development staff, and others as necessary to perform assignments. Conduct meetings with business stakeholders to actively analyze customer requirements. Coordinate changes to functional specifications that occur during development and update functional specifications as required. Participate in developing work plans and organizing project resources for optimal performance. Serve as the primary technical liaison for clients, aligning integration solutions with broader business, operational, and workplace goals. Lead multi-stakeholder workshops and presentations, clearly articulating integration priorities and constraints to both executive and technical audiences. Minimum Requirements: Masters degree required. Minimum 10 years total experience. 2-5 years of Veteran Affairs Claims system/processing experience Agility and ability to change course based on shifting plans, priorities, and timelines. Strong analytical, problem-solving, facilitation, and communication skills, including written, verbal, and interpersonal. Excellent organizational skills and strong attention to detail. The ability to obtain Public Trust Clearance. Preferred Qualifications: Prior experience working in a healthcare organization (e.g., hospital, health system, health insurance company, military health etc.). Benefits (including but not limited to): Health, dental, and vision plans Optional FSA Paid parental leave Safe Harbor 401(k) with employer contributions 100% vested from day 1 Paid time off and 11 paid holidays No cost group term life/AD&D plan, and optional supplemental coverage Pet insurance Monthly phone and internet stipend Tuition and training reimbursement This range is not a guarantee of compensation or salary, as Trilogy Federal conducts an individual equity review for every candidate based on experience, location, education, industry experience, and comparisons to internal pay bands. In addition to salary, Trilogy offers robust benefits including medical/dental/vision insurance coverage, 401(k) match, paid holidays, paid time off, tuition reimbursement, and a very supportive work/life balance. Regarding remote positions, Trilogy Federal is able to offer virtual employment in the following states: Colorado, Connecticut, D.C., Florida, Georgia, Illinois, Maryland, New York, South Carolina, Texas, and Virginia. Trilogy Federal is an Equal Employment Opportunity employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.