Role OverviewWe are seeking aRole OverviewWe 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 ResponsibilitiesLead business analysis activities across PHI initiatives impacting membership management, product configuration, premium billing, and claims processingWork 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 paymentsClaims submission, assessment, and benefit calculationAnalyse and document as-is and to-be processes, business rules, and system interactionsSupport initiatives involving external PHI interfaces,



including:HICAPS (electronic and POS claiming)ECLIPSE (hospital and medical claiming)Medicare coordination and related interactionsTranslate business requirements into transparent functional specifications and user storiesCollaborate with solution designers, developers, and testers to ensure requirements are correctly implementedSupport SIT and UAT by defining PHI-relevant test scenarios and validating outcomes against expected business rulesAssist with implementation activities, change impacts, and post-release supportMandatory Skills & ExperienceProven experience as a Senior Business Analyst within the Australian PHI domainStrong understanding of core PHI operations, including:Membership and policy administrationProduct and benefit structuresPremiums, payments, and billing cyclesClaims processing and benefit calculationExperience supporting or analysing PHI integrations such as HICAPS, ECLIPSE, and MedicareAbility to interpret fund rules and translate them into system and data requirementsStrong documentation skills (business requirements, functional specs, process flows, user stories)Experience working in Agile, Waterfall, or hybrid delivery environmentsStrong stakeholder engagement and communication skillsDesirable ExperienceExperience working with PHI core systems.Exposure to PHI reporting, data, or reconciliation processesExperience supporting cutover, deployment, or go-live activitiesFamiliarity with common BA tooling (JIRA, Confluence, Visio, etc.)Key AttributesSolid understanding of PHI business processes and terminologyAnalytical and detail-orientedComfortable working in regulated environmentsCollaborative and delivery-focused
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📌 Senior Business Analyst – Private Health Insurance (Phi) (New South Wales)
🏢 Advance Delivery Consulting
📍 New South Wales