Senior Business Analyst - Private Health Insurance (PHI)

Role Overview

We are seeking a Senior Business Analyst with strong Australian Private Health Insurance (PHI) experience, particularly across memberships, products, premiums, and claims. This role supports business and technology initiatives within a health fund environment and requires a practical understanding of how PHI operations translate into system behaviour and data outcomes.

The successful candidate will be comfortable working across core PHI processes and supporting integrations with Medicare, HICAPS, and ECLIPSE, while collaborating closely with business SMEs and delivery teams.

Key Responsibilities

• Lead business analysis activities across PHI initiatives impacting membership management, product configuration, premium billing, and claims processing
• Member lifecycle events (joins, transfers, suspensions, terminations)
• Product and cover structures (Hospital, Extras, combined covers)
• Premium calculation, payment frequency, arrears, and advance payments
• Claims submission, assessment, and benefit calculation
• Analyse and document as-is and to-be processes, business rules, and system interactions
• Support initiatives involving external PHI interfaces, including:
• HICAPS (electronic and POS claiming)
• ECLIPSE (hospital and medical claiming)
• Medicare coordination and related interactions
• Translate business requirements into clear functional specifications and user stories
• Collaborate with solution designers, developers, and testers to ensure requirements are correctly implemented
• Support SIT and UAT by defining PHI-relevant test scenarios and validating outcomes against expected business rules
• Assist with implementation activities, change impacts, and post-release support

Mandatory Skills & Experience

• Proven experience as a Senior Business Analyst within the Australian PHI domain
• Strong understanding of core PHI operations, including:
• Membership and policy administration
• Product and benefit structures
• Premiums, payments, and billing cycles
• Claims processing and benefit calculation
• Experience supporting or analysing PHI integrations such as HICAPS, ECLIPSE, and Medicare
• Ability to interpret fund rules and translate them into system and data requirements
• Strong documentation skills (business requirements, functional specs, process flows, user stories)
• Experience working in Agile, Waterfall, or hybrid delivery environments
• Strong stakeholder engagement and communication skills

Desirable Experience

• Experience working with PHI core systems.
• Exposure to PHI reporting, data, or reconciliation processes
• Experience supporting cutover, deployment, or go-live activities
• Familiarity with common BA tooling (JIRA, Confluence, Visio, etc.)

Key Attributes

• Solid understanding of PHI business processes and terminology
• Analytical and detail-oriented
• Comfortable working in regulated environments
• Collaborative and delivery-focused