SIU Coordinator

Martin's Point Health Care • Portland, ME

4d

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 is 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 serves as an entry point into an investigative career path.

Employees are expected to work consistently to 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.
• Discretion when handling PHI and sensitive investigative information.
• Highly organized, detail oriented, and disciplined about deadlines.
• Demonstrates 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 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 from the department template library under the Director’s or an Investigator’s direction.
• 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.

Benefits

• Medical benefits
• Dental benefits
• Vision benefits
• Retirement savings with employer contributions
• Paid time off, including volunteer time off
• Pie day
• Other employee benefits

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree