Compliance & Fraud Monitor — Hybrid (Remote/Onsite)

AHA; Melbourne; Hybrid; AUD 85,000 - 110,000; Full time

Benefits offered by this job

Flexible hybrid work (up to 4 days WFH

Office-based in Melbourne CBD

Equipment provided

Ongoing training and support

Supportive team environment

Job summary

AHA is seeking a Monitoring, Audit and Fraud Officer to join the Pharmacy Programs Administrator (PPA) team in Melbourne. You will assess claims data, verify eligibility, and liaise with providers to identify compliance issues and potential fraud.

The role supports government-funded pharmacy programs and requires meticulous investigations. Flexible hybrid work arrangements are offered, with office days in Melbourne CBD, ongoing training, and a collaborative team environment.

Qualifications

• 3+ years of experience in a compliance or project administration role.
• Excellent attention to detail and investigative skills.
• Exceptional communication skills, both written and verbal.
• Intermediate to advanced Microsoft Office suite skills – Word, Excel, Outlook.

Responsibilities

• Assess and analyse claims data against supporting evidence.
• Review eligibility of Service Providers and claims in line with program rules.
• Liaise with Service Providers and Department representatives regarding compliance matters.
• Draft a range of compliance communications, including bulletins and letters highlighting common issues and improvement opportunities.
• Contribute to weekly, monthly and quarterly reports for the Department.
• Collaborate with the PPA Support Centre and PPA Program Leads to address non-compliance issues.
• Record, assess and investigate compliance tip-offs.
• Maintain accurate records of compliance activities and investigations.

Skills

Attention to detail

Investigative skills

Excellent communication

MS Office

Education

Tertiary qualification in business/health/pharmacy

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

AHA is seeking a Monitoring, Audit and Fraud Officer to join the Pharmacy Programs Administrator (PPA) team in Melbourne. You will assess claims data, verify eligibility, and liaise with providers to identify compliance issues and potential fraud.

The role supports government-funded pharmacy programs and requires meticulous investigations. Flexible hybrid work arrangements are offered, with office days in Melbourne CBD, ongoing training, and a collaborative team environment.