Fraud Intelligence & Risk Manager

About the role

Medibank is strengthening how it identifies, understands and prevents fraud across members, healthcare providers and internal activity. Reporting to the Head of Payment Integrity, this role leads the fraud intelligence and investigations function and shapes the next phase of fraud maturity. It connects intelligence, investigations, prevention, controls and risk governance to improve customer, financial and operational outcomes, and leads a team of fraud investigators.

Key responsibilities

• Lead fraud intelligence and investigations across detection, triage, investigation, recovery and referral.
• Mature an intelligence-led approach to spotting fraud patterns, typologies, networks and emerging threats.
• Translate insights into action and strengthen the link between investigations, intelligence, prevention and control improvement.
• Partner with Data & Analytics and Technology teams to improve detection, analytics and the responsible use of AI.
• Develop and coach a high-performing team while maintaining investigation standards, quality assurance and procedural fairness.
• Strengthen investigation standards, governance, reporting and quality assurance.
• Advise senior leaders and governance forums on fraud trends, risks and control effectiveness.
• Support risk management, control uplift and fraud governance across the Health Partnerships & Networks Hub.

Required profile

• Experienced fraud, intelligence, investigations or financial crime leader with strong analytical capability and commercial judgement.
• Experience leading such a function in a complex or regulated environment.
• Experience building, transforming or maturing a capability, framework, operating model, intelligence process or control environment.
• Experience identifying fraud patterns, typologies, networks or systemic vulnerabilities and turning them into prevention or control improvements.
• Experience partnering with data, analytics, technology or operational teams to improve detection and prevention.
• Experience in healthcare, insurance, provider or claims-related fraud is highly regarded but not essential.

Required skills

• People leadership and team development.
• Stakeholder management and influencing.
• Understanding of governance, risk and control management.
• Ability to communicate complex information clearly to senior stakeholders.