[Hiring] SIU Coordinator @Martin’s Point Health Care

Role Description

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, managing referral intake and preliminary claims research, medical records requests, standard written correspondence, deadline tracking, case management system administration, and metrics reporting. It reports to the Director, SIU, and serves as an entry point into an investigative career path.

Primary Duties and Responsibilities

• Manages SIU intake: Receives, logs, and acknowledges referrals from the hotline, internal departments, members, providers, and external agencies.
• Conducts preliminary research to support triage, including eligibility, claims history, and provider enrollment.
• Coordinates medical records requests: Tracks due dates, follows up on outstanding requests, and maintains records intake and documentation logs.
• Prepares and issues standard SIU correspondence from the SIU department template library under the Director’s or Investigator’s direction.
• Maintains the SIU case management system and SharePoint site, keeps the data accurate, and runs routine reports.
• Compiles monthly and quarterly SIU metrics for leadership, the Compliance Committee, and regulatory reporting.
• Tracks regulatory and contractual deadlines, including referral timeframes and responses to CMS and DHA requests for information.
• Helps investigators with claims data pulls, spreadsheet analysis, and exhibit preparation.
• May investigate low-complexity cases under supervision.
• Employees are expected to work consistently to demonstrate the mission, vision, and core values of the organization.

Qualifications

• Education: Associate’s degree or an equivalent combination of education and experience required; Bachelor’s degree preferred.
• Experience: Two or more years in health plan SIU operations, claims, compliance, or payment integrity required; experience with case management systems and SharePoint preferred.
• Knowledge: Knowledge of medical terminology and claims processing preferred.
• Skills:
  • Intermediate to advanced Excel skills.
  • Clear, professional written communication.
  • Discretion with PHI and sensitive investigative information.
  • Interest in developing investigative skills.
• Abilities:
  • Demonstrates an understanding of and alignment with Martin’s Points values.
  • Highly organized, detail oriented, and disciplined about deadlines.

Requirements

• Pay Range: $65,725.40 - $81,190.20
• Final compensation is determined at the conclusion of the interview process.
• Encouragement to apply even if desired compensation falls outside of the listed range.

Benefits

• Comprehensive benefits package including medical, dental, and vision.
• Retirement savings with employer contributions.
• Paid time off (including volunteer time off!).
• Additional employee benefits such as pie day.

Company Description

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.