SIU Coordinator - Remote

Martin’s Point Health Care•Portland, ME

5d•$65,725 - $81,190•Remote

About The Position

The SIU Coordinator provides operational, administrative, and analytical support to the Special Investigations Unit (SIU) across the Generations Advantage and US Family Health Plan lines of business. The Coordinator serves as the SIU’s intake hub and manages referral intake and preliminary claims research, medical records requests, standard written correspondence, deadline tracking, case management system administration, and metrics reporting. The position reports to the Director, SIU, and offers an entry point into an investigative career path. The Coordinator supports investigators with claims data pulls, spreadsheet analysis, and exhibit preparation, and may investigate low-complexity cases under supervision. Employees are expected to consistently demonstrate the organization’s mission, vision, and core values.

Requirements

Associate’s degree or an equivalent combination of education and experience.
Two or more years of experience in health plan SIU operations, claims, compliance, or payment integrity.
Intermediate to advanced Excel skills.
Clear, professional written communication skills.
Discretion when handling protected health information (PHI) and sensitive investigative information.
Highly organized, detail oriented, and disciplined about deadlines.
Understanding of and alignment with Martin’s Point values.
Interest in developing investigative skills.

Nice To Haves

Bachelor’s degree.
Experience with case management systems and SharePoint.
Knowledge of medical terminology and claims processing.

Responsibilities

Receive, log, and acknowledge SIU referrals from the hotline, internal departments, members, providers, and external agencies.
Conduct preliminary research to support referral triage, including eligibility, claims history, and provider enrollment.
Coordinate medical records requests, track due dates, follow up on outstanding requests, and maintain records intake and documentation logs.
Prepare and issue standard SIU correspondence using department templates under the direction of the Director or an Investigator.
Maintain the SIU case management system and SharePoint site, ensure data accuracy, and run routine reports.
Compile monthly and quarterly SIU metrics for leadership, the Compliance Committee, and regulatory reporting.
Track regulatory and contractual deadlines, including referral timeframes and responses to CMS and DHA requests for information.
Assist investigators with claims data pulls, spreadsheet analysis, and exhibit preparation.
Investigate low-complexity cases under supervision, as needed.
Demonstrate the organization’s mission, vision, and core values.