Pharmacy Integrity Manager

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Bupa is Australia's largest health insurer and is committed to helping people live longer, healthier and happier lives in a better world. It supports the health and wellbeing needs of more than 4.7 million health insurance customers. Bupa has embarked on a global transition from Health Insurer to a Healthcaring company with the goal of becoming the world's most customer centric organisation.

About the opportunity

This role will be a member of the Claims Integrity & Provider Capability Transformation (IC&PCT) Leadership Team and plays a critical role in ensuring the safe, effective, and cost-efficient delivery of pharmaceutical benefits within Bupa Health Insurance. This position is responsible for overseeing the implementation of pharmacy policies and practices that align with regulatory requirements and company goals, while contributing to the development of health insurance products.

This role works closely with internal teams and stakeholders to optimise pharmaceutical benefits, manage medication-related risks, and maintain the drug database to ensure accurate payment for member benefits in compliance with Bupa policies and regulations. Additionally, the role involves providing guidance and approval for high-cost drug requests in accordance with hospital contract obligations and supporting initiatives aimed at improving health outcomes and controlling pharmacy-related costs.

Through strategic leadership and expert pharmaceutical guidance, the Pharmacy Integrity Manager helps enhance the overall value of health insurance offerings, ensuring that members have access to the most appropriate and affordable medications.

About the role

This is a full-time, permanent position based in Melbourne, Sydney, Brisbane, or Adelaide.

This position is a hybrid role - while primarily work-from-home, you may be required to attend the CBD office occasionally to collaborate with the broader team.

This role uniquely blends the clinical expertise of pharmacy with the strategic, corporate side of healthcare. In this position, you will:

• Manage and maintain the Drug Database and related collateral, ensuring medications listed for reimbursement align with Pharmacy and Product Policies.
• Provide expert pharmaceutical advice to product teams, ensuring compliance with private health insurance legislation and regulations.
• Ensure Bupa adheres to PBS, TGA, and other regulatory standards relating to drug coverage and reimbursement.
• Review and assess high-cost drug claims for alignment with hospital agreements and health insurance policies.
• Analyse pharmaceutical data to identify trends, risks, or potential claims leakage.
• Advise the hospital contracting team on high-cost drug clauses during contract negotiations, offering insights into pricing, reimbursement models, and regulatory requirements.

About You

You are a Registered Pharmacist with a strong foundation in pharmacy practice and a strategic mindset that extends beyond day-to-day operations. You bring:

• Registered Pharmacist with a Bachelor of Pharmacy (or equivalent).
• 5+ years' experience across clinical, hospital, community, or industry settings.
• Strong knowledge of high-cost medicines, funding frameworks, and relevant regulations (PBS, TGA, private health insurance).
• Strategic thinker with the ability to challenge the status quo and shape forward-looking initiatives.
• Skilled communicator with proven influence across senior leaders, clinicians, and operational teams.
• Adaptable problem-solver who thrives in complex environments.
• Self-starter with a strong delivery focus; postgraduate qualifications (e.g. Masters, MBA, Health Economics) desirable.

The CI&PCT team are a passionate and professional group of individuals that really care about the work they do. Operating in a unique corporate and clinical environment with extremely high standards, compliance, and contractual obligations and are known for being driven and responsive to the needs of our Health Insurance members, putting our customers at the centre of everything we do.

Ready to make an impact on Australia's healthcare sector? Apply now and take the next step in your career with Bupa.

This role is currently open; applications may close early if we receive a high volume of interest.

Bupa is an equal opportunity employer and is committed to equality in recruitment, development, retention and promotion of staff. We encourage people from all backgrounds to apply.

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• Hospitals and Health Care

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