Fraud & Compliance Investigator – Health Programs

Australian Healthcare Associates Pty; Melbourne; Hybrid; AUD 75,000 - 110,000; Full time

Benefits offered by this job

Attractive salary

Flexible working (hybrid)

Tech equipment provided

Training and support

Collegiate team environment

Job summary

Australian Healthcare Associates Pty (AHA) is seeking a Monitoring, Audit and Fraud Officer to join the Pharmacy Programs Administrator (PPA) project in Melbourne. You will assess claims data, review eligibility, and help ensure compliance while identifying potential fraud and non-compliance issues.

The role reports to the team Manager, involves a mix of work from home (up to 4 days per week) and office-based duties, and offers an attractive salary and ongoing training within a supportive,

Qualifications

• Attention to detail and investigative skills essential.
• Excellent written and verbal communication abilities.
• Proficiency with Microsoft Office suite required.

Responsibilities

• Assess and analyse claims data against supporting evidence.
• Review eligibility of Service Providers and claims per program rules.
• Liaise with Service Providers and Department representatives on compliance matters.
• Draft compliance bulletins and letters highlighting issues and improvements.
• Contribute to weekly, monthly and quarterly Department reports.
• Collaborate with PPA Support Centre and PPA Program Leads to address non-compliance.
• Record, assess and investigate compliance tip-offs.
• Maintain accurate records of compliance activities and investigations.

Skills

Attention to detail

Investigative skills

Communication skills

Autonomy and teamwork

Education

Tertiary qualification in business/health/pharmacy

Tools

Microsoft Word

Microsoft Excel

Outlook

Job description

Australian Healthcare Associates Pty (AHA) is seeking a Monitoring, Audit and Fraud Officer to join the Pharmacy Programs Administrator (PPA) project in Melbourne. You will assess claims data, review eligibility, and help ensure compliance while identifying potential fraud and non-compliance issues.

The role reports to the team Manager, involves a mix of work from home (up to 4 days per week) and office-based duties, and offers an attractive salary and ongoing training within a supportive,