Pega Business Architect

at  Bupa

OPPORTUNITY SNAPSHOT:

Reporting to the Capability Lead Claims within the Capability Modernisation Program the Pega Business Architect will have expertise in the Pega Smart Claims Solution. This role will be responsible for configuring and managing claims rules within the Pega Smart Claims platform, aligning claims management processes with business goals and regulatory requirements. The role will work closely with cross-functional teams, including claims operations, technology, and compliance, to streamline and automate claims processing, ensuring accuracy, efficiency, and enhanced customer & provider experiences.
This role will have strong business analysis skills and a deep understanding of health insurance claims to make a significant impact on Bupa’s claims transformation journey.

QUALIFICATIONS, TRAINING & EXPERIENCE

• 4+ years of relevant Pega Decisioning experience.
• Pega Decisioning project experience through all phases of the project lifecycle from scoping and planning, requirements gathering, design, development, testing, and go live.
• Pega Decisioning certification.
• Bachelor’s Degree or equivalent professional experience
• Minimum of 5 years of experience in business architecture, business analysis, or claims management within the health insurance sector.
• Proven experience working with Pega Smart Claims Solution or similar Pega platforms, with hands-on experience in configuring claims rules and workflows.
• Strong understanding of health insurance claims processes, including policy eligibility, benefits, claim adjudication, payments, and denials.
• Solid knowledge of Australian health insurance regulations, such as the Private Health Insurance Act, APRA, and other relevant standards.
• Experience in business process automation, workflow design, and process optimization within claims management systems.
• Proficiency in documenting business requirements, functional specifications, and user stories.
• Strong problem-solving skills and the ability to analyse and address complex business challenges.
• Excellent communication and interpersonal skills, with the ability to collaborate effectively with technical and non-technical teams.
• Strong understanding of agile methodologies and experience working in an agile environment.
• Familiarity with Agile and Scrum development practices.
• Experience in health insurance industry compliance and regulatory frameworks.
• Experience with user acceptance testing (UAT) and system deployment.
• Knowledge of reporting and data analytics tools to assess claims processing performance.

Please refer the Job description for details