Sr. Program Analyst, Federal Health

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Sr. Program Analyst, Federal Health

Remote
• Business Development and Growth

Full-time

At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care.

With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.?

The Sr. Program Analyst, Federal Health will serve as a subject matter expert (SME) in VA disability benefits adjudication and federal program analysis. This role will translate deep regulatory knowledge of VA disability rating criteria into structured business logic for AI model training and validation, evaluate evidence sufficiency across VA disability claims, and support federal program delivery activities.

• 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 backwards from that definition 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 — validating that the AI accurately and concisely organized the 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 throughout program delivery.
• Demonstrate ability to coordinate with fellow SMEs, 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 voice when required by the program team.
• Prepare written deliverables including analytical memos, criteria documentation, and structured feedback reports suitable for both technical and executive audiences.

• 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…