Job Description
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
Work with business stakeholders to capture and document requirements related to:
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
Job Type: Full-time
Pay: $100,000.00 – $110,000.00 per year
Work Location: In person
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
Work with business stakeholders to capture and document requirements related to:
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
Job Type: Full-time
Pay: $100,000.00 – $110,000.00 per year
Work Location: In person
💡 Quick Summary
Seeking a career-building opportunity? The Senior Business Analyst – Private Health Insurance (PHI) position is now open for candidates interested in the Insurance sector. This role in Sydney offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in Insurance is a plus.
