Wurtzbach joined the Binibining Pilipinas Pageant three times before winning the Binibining Pilipinas Universe title. During Binibining Pilipinas 2013, she was named as the 1st Runner-up. She joined the Binibining Pilipinas 2014, but only placed in the top 15. A controversy erupted when she failed to win any title following her question-and-answer portion. She was asked a question in Tagalog by a Filipino judge, Senator Sonny Angara, which she answered in Tagalog. Online commentators wondered if the question and answer in Tagalog cost her points from the international judges and, therefore, any title that year. On her third attempt for the title in 2015, she won the highest title, Miss Universe Philippines and went on to compete in the Miss Universe 2015 Pageant. During the question and answer portion of the pageant she was asked by then-Camarines Sur Representative Leni Robredo: “Social media is now a very powerful tool on communication. Can you tell us your thoughts about internet censorship?” She answered:

Wurtzbach represented the Philippines in the 2015 Miss Universe contest held on December 20, 2015 in Las Vegas, Nevada, United States. During the first question and answer round, Wurtzbach was asked by host Steve Harvey, “earlier this year, there was a controversy in the Philippines about the United States reopening a military base in your country. Do you think the United States should have a military presence in your country?” Wurtzbach answered:

On January 21, 2016, she traveled to Bali in Indonesia to shoot a commercial for C 1000, a vitamin brand available in Indonesia. Two days later, on January 23, 2016, she arrived in the Philippines for a week-long homecoming celebration with visits to the cities of Manila, Makati, Pasay and Quezon City. She also made courtesy calls to the Congress of the Philippines, Senate of the Philippines and Malacañang Palace.

On February 1, 2016, she arrived in San Francisco to fulfill her duties as Inside Edition’s special correspondent for Super Bowl 50. While in San Francisco, she was also reunited with Janine Tugonon, Miss Universe 2012 1st Runner-up from the Philippines.

On February 28, 2016, she travelled to Toronto, Canada to deliver a speech against bullying at the Speakers Forum for the International Students of the Language Academy of Canada wherein she shared some of her childhood experiences as a victim of bullying. During her stay in Canada, she was reunited with Miss Universe Canada 2015, Paola Nunez Valdez. She also met and gave some advice to the contestants of Miss Universe Canada 2016.

On March 25, 2016, Wurtzbach returned to the Philippines for an unannounced visit to take care of some personal things including renewing her Philippine passport, charity works and film a new commercial for Philippine Airlines. She also met and gave advice to the candidates of Binibining Pilipinas 2016 during their press presentation. On April 12, 2016 she returned to the Philippines for the Binibining Pilipinas 2016 pageant and on April 17 crowned her successor Maxine Medina as Miss Universe Philippines 2016 during the coronation night. During the pageant she was reunited with Miss Myanmar 2015, May Barani Thaw and Miss Malaysia 2015, Vanessa Tevi while Miss USA 2015, who at Miss Universe, placed 2nd runner-up, Olivia Jordan served as a judge. Wurtzbach’s farewell speech and walk at Binibining Pilipinas 2016 as Miss Universe Philippines 2015, trended at social media with enormous hits.

On April 21, 2016, Wurtzbach arrived in Peru to attend Miss Peru 2016 pageant where she served as a judge. She also had a press conference a day before the pageant and was greeted by the Lima City Mayor, Luis Castaneda and received an honor of being “The Distinguished Guest of Lima”. Wurtzbach along with Miss Peru 2015, Laura Spoya crowned Valeria Piazza, Miss Peru 2016.

On April 27, 2016, Wurtzbach threw out the ceremonial first pitch for the New York Mets. A month later on May 27, 2016, Wurtzbach travelled to Machala, Ecuador to help the victims of the recent earthquake that killed the lives of at least 600 people. She was welcomed by the mayor of Machala, Carlos Falquez Batallas to the city and was named as an honorary volunteer of the Guayas Red Cross wherein she was invited to participate in the global appeal of raise resources to build 6,000 homes for the earthquake victims. She was also given a chance to meet Connie Jiménez, Miss Ecuador 2016 during her visit.

In June 2016, Wurtzbach represented the Philippines and the Miss Universe Organization in a high-level meeting of the United Nations that aimed at ending AIDS.

Although a practising Roman Catholic, Wurtzbach openly supports views contrary to the teachings of the Catholic Church, particularly the distribution of birth control via full implementation of the Philippines’ Reproductive Health Law and the recognition of LGBT rights in the Philippines. On December 13, 2016, she received a personal rosary from Pope Francis.

Wurtzbach is an advocate for gender equality. On Instagram she declared her support for the LGBT community in light of the Orlando nightclub shooting in 2016. In 2018, she called on the Philippine Senate to pass the SOGIE Equality Bill. In 2017, Wurtzbach was named a UNAIDS Goodwill Ambassador for Asia and the Pacific.

After becoming Miss Universe 2015, she returned to ABS-CBN after signing a two-year exclusive contract on October 9, 2017. She appeared as a guest host in ASAP and is currently hosting World of Dance Philippines with Luis Manzano.

As a parting gift on her final official photoshoot, Wurtzbach was granted access to the elusive Mikimoto Crown. Wurtzbach relinquished her Miss Universe crown and passed it on to Iris Mittenaere of France at the 65th Miss Universe pageant, held on January 30, 2017 in Manila, Philippines.

On January 30, 2017, Wurtzbach revealed that she has signed a contract with WME/IMG’s IMG Universe division where she will continue to work with the Miss Universe Organization as an HIV/AIDS awareness advocate after her reign.

She costarred with Vice Ganda and Daniel Padilla in a film under production of Star Cinema. The project served as her acting comeback after six years and her first film in more than a decade. The film entitled Gandarrapido: The Revenger Squad served as one of the eight official film entries in the 2017 Metro Manila Film Festival.

Wurtzbach has tweeted that she intends to remain unmarried and childfree. In June 2020, she confirmed her relationship with Scottish entrepreneur Jeremy Jauncey. She had dated Filipino-Swiss race-car driver Marlon Stöckinger.