Utilization Review Specialist (UR Nurse) - Insurance industry

Responsibilities:

• Daily perform concurrent review activities by continuously reviewing and auditing patient treatment files and make sure that all activities are align with company strategies and comply with regulation
• Ensure that customer won't receive unnecessary procedures, ineffective treatment, or unnecessarily extensive hospital stays.
• Monitoring customer and provider network behavior and escalate to stakeholder
• Performs other duties as assigned

Qualifications:

• Bachelor's degree in Nursing or a related field.
• Minimum 2-3 years of experience in hospital nursing, preferably in ward or ICU settings.
• At least 1 year of experience in life or non-life insurance and health claims (preferred).
• Proven training and competency in negotiation, quality assurance, and case management outcomes.
• Strong communication skills in Thai and English, both written and spoken (preferred)
• Have full working rights for Thailand