Senior Business Analyst – Private Health Insurance (PHI)

Advance Delivery Consulting; Hornsby; On-site; AUD 90,000 - 130,000; Full time

Job summary

Advance Delivery Consulting is seeking a Senior Business Analyst with strong Australian Private Health Insurance (PHI) experience. You will work across membership management, product configuration, premiums, and claims, coordinating with stakeholders and delivery teams to translate business requirements into functional specifications.

You will collaborate with SMEs and IT to support PHI integrations with HICAPS, ECLIPSE, and Medicare, and contribute to testing and cutover activities.

Qualifications

• Senior BA with Australian PHI domain experience
• Strong understanding of PHI operations: membership, product, premiums, and claims
• Experience with PHI integrations such as HICAPS, ECLIPSE, and Medicare
• Solid documentation skills: BRDs, functional specs, process flows, user stories

Responsibilities

• Lead business analysis across PHI initiatives affecting membership management, product configuration, premium billing, and claims processing
• Capture and document requirements: member lifecycle events, product structures, premium and payment rules, and claims
• Translate requirements into clear functional specifications and user stories; collaborate with designers, developers, and testers
• Support SIT/ UAT by defining PHI test scenarios and validating outcomes against business rules
• Assist with implementation activities, change impacts, and post-release support

Skills

PHI domain knowledge

Stakeholder engagement

Requirements gathering

Functional specifications

Tools

JIRA

Confluence

Visio

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