Risk & Investigations Manager

You’re only human. 

It’s a strange thing to say, because us humans are capable of incredible things. And at Medibank, we know our greatest potential lies in the people who work with us.   

We strive to make real, fundamental change, driven by a simple purpose: to create the best health and wellbeing for all of Australia.  

The Opportunity – Fraud Intelligence & Risk Manager

This role plays a critical part within our Payment Integrity Team, you will drive the development of an intelligence-led capability that strengthens fraud detection, prevention and recovery outcomes across member, provider and internal fraud.

Reporting to the Head of Payment Integrity, you will lead a team of fraud specialists while partnering with stakeholders across the business to deliver insights, strengthen controls and support effective risk management practices across the Health Partnerships & Networks Hub.

How you will create value

In this broad and dynamic leadership role, you will add value by:

• Leading Medibank's fraud intelligence and investigations capability, overseeing the end-to-end fraud lifecycle across detection, triage, investigation, recovery and referral activities.
• Driving the development of an intelligence-led approach to identifying fraud patterns, networks, typologies and emerging threats across member, provider and internal fraud.
• Partnering with Data, Technology and operational teams to enhance fraud detection, analytics, artificial intelligence capabilities and preventive controls.
• Leading and developing a high-performing investigations team, ensuring consistent investigation standards, quality assurance and procedural fairness across all activities.
• Translating investigation outcomes and insights into sustainable control improvements that reduce fraud exposure, claims leakage and operational risk.
• Providing reporting, insights and recommendations to senior leaders and governance forums on fraud trends, emerging risks, incidents and control effectiveness.
• Coordinating first-line risk management activities across the Health Partnerships & Networks Hub, including risk, incident, control and remediation management.

About you

You are an experienced fraud, intelligence or investigations leader who thrives in a complex and highly regulated environment. With strong analytical capability and commercial judgement, you can identify emerging risks, connect complex information and translate insights into meaningful business outcomes. You are comfortable leading teams, influencing senior stakeholders and balancing customer, financial and risk considerations to drive better decisions and sustainable outcomes.

Key attributes and experience include:

• Demonstrated experience leading fraud investigations, fraud intelligence, financial crime or a related investigations function within a complex or regulated environment.
• Proven people leadership experience, including developing team capability, setting standards and providing direction on complex or sensitive matters.
• Strong knowledge of investigation methodologies, evidence requirements, case management, procedural fairness and external referral processes.
• Experience identifying fraud patterns, networks, typologies and systemic vulnerabilities and translating findings into preventive controls and detection improvements.
• Experience partnering with data, analytics and technology teams to improve fraud detection, prioritisation and prevention outcomes.
• Working knowledge of operational risk management, including risks, incidents, controls, issues and remediation activities.
• Strong stakeholder management, influencing and communication skills, with the ability to present complex findings and recommendations clearly to senior leaders.
• Experience working with law enforcement, regulators or industry bodies, along with knowledge of healthcare, insurance or claims-related fraud, will be highly regarded.

Imagine working with us 

We understand that work means different things to everyone...  We know happy, healthy people make great teams, and great teams put more heart into each customer and patient interaction. And that’s why we’re reinventing work.    

Imagine a workplace that helps you and your family thrive.  Where connection, personal development and health and wellbeing are front of mind. To learn more about our benefits go to https://careers.medibank.com.au/culture/rewards-benefits/

For you, work should help you Live Better. It should bring you fulfillment and joy. And with Medibank, it could. 

Inclusion and Accessibility  

We believe in everyone's potential and strive to make Medibank inclusive for all because different perspectives make us better. We encourage applications from everyone, including Aboriginal and Torres Strait Islander peoples, neurodivergent candidates, LGBTQIA+ community including transgender and gender diverse candidates and candidates with a disability.

If you need adjustments or alternative formats at any stage of the recruitment or employment journey, we’re here to help.  You can let us know directly in the application form, or if you’d prefer to discuss before applying, please reach out to us ••••@medibank.com.au or (03) •••• •666. Learn more about our commitments and employee stories at https://careers.medibank.com.au/diversity-inclusion/(please copy and paste the URL onto your browser)

Medibank proudly recognised as Best Enterprise Organisation, 2026 AFR BOSS Best Places to Work