Reviewer

• Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement.
• Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers.
• Collaborate with team leaders to ensure thorough review of DRG denials.
• Conduct audits in alignment with organizational quality and timeliness standards.
• Use proprietary auditing systems proficiently to make consistent determinations and generate audit letters.
• Recommend improvements to the audit system to enhance efficiency.
• Ensure compliance with HIPAA regulations for protected health information.
• Perform other duties as assigned.

DRG Reviewer

• Review patient documentation for each device category against CMS LCD criteria and payer-specific requirements.
• Identify documentation gaps and generate structured deficiency notices to clinicians and prescribers.
• Build and maintain criteria checklists per code block, aligned with the Clinical Intelligence Lead's agent guides.
• Audit HITL team reviews for criteria accuracy and consistency.
• Flag payer-specific deviations (e.g., UHC requirements that differ from Medicare) and document them in the policy library.
• Collaborate with the Protocol Specialist to update criteria sets when LCDs change.
• Support prior authorization packet assembly, ensuring each packet maps to the coverage criteria for the relevant payer.

DME Documentation Criteria Reviewer

• Review AI-generated video outputs for sharpness, clarity, detail retention, and overall visual fidelity.
• Identify compression artifacts, aliasing, noise patterns, ringing, temporal inconsistencies, and other quality defects.
• Conduct frame-by-frame analysis to assess image integrity and consistency.
• Help establish quality benchmarks and review criteria for video enhancement and super-resolution models.
• Identify the visual characteristics that most strongly influence perceived quality and realism.
• Curate examples of both high-quality and challenging visual content for model evaluation.
• Assist in developing standardized reference sets for testing and comparison.
• Translate complex visual observations into clear, actionable feedback and evaluation documentation.
• Contribute to annotation frameworks, reviewer guidelines, and quality assessment rubrics.
• Work alongside AI researchers, engineers, and creative professionals to improve model evaluation methodologies.

Visual Quality Reviewer – Super Resolution

• Write & review Environmental Site Assessment (ESA) assignments.
• Provide solid recommendations and solutions to Managing Directors and clients while understanding the assessment’s potential impact on the transaction process.
• Oversee quality control throughout the project’s life cycle.
• Manage field technician during site visits and occasionally lead fieldwork activities as necessary.
• Complete research (historical, regulatory, etc.).
• Communicate with client and subject site representatives.
• Conduct appropriate site reconnaissance.
• Data compilation and organization.
• Prepare quality supporting documentation (site figures, appendices, etc.).
• Other tasks as assigned by the Managing Director, associated with the report deliverable schedule and plan.

Senior ESA Reviewer

• Evaluate and review disability claims from home
• Work with a panel of independent physicians
• Maintain flexibility in scheduling and workload

Neuro-Ophthalmology Disability Peer Reviewer

• Evaluate medical records
• Prepare concise clinical summaries
• Provide independent medical opinions in response to specific client questions
• Assess medical necessity, causation, work-relatedness, impairment, disability status, return-to-work recommendations, and appropriateness of treatment
• Conduct evidence-based clinical assessments
• Prepare clear, comprehensive written reports
• Participate in peer-to-peer discussions when necessary
• Answer client-specific questions regarding occupational injuries, illnesses, and workplace health concerns
• Apply current clinical guidelines and standards of care to all reviews

Occupational Medicine Reviewer

• Primary review of all premium audits - primarily General Liability (Workers Compensation, General Liability, Garage, Auto Liability, etc)
• Audits methods include: Physical, Remote Physical, Virtual, Phone, Mail
• Independently determines if each audit adequately addresses the Afirm QC Requirements, state-specific requirements, and client-specific requirements
• Validate time charges with audit detail and/or explanations
• Manage inventory of audits to review
• Work to develop auditor quality by providing technical help and clear information through direct communication with the auditors during the review process, or as otherwise requested by the Davies QC Department management
• Meet production requirements and expectations as provided
• Perform other duties as assigned

Premium Audit Reviewer

• Pre-underwrite loan files by reviewing borrower documentation such as credit reports, income documents, and assets to ensure accuracy and completeness.
• Assist with income calculations and verify supporting documents.
• Support senior underwriters in identifying potential risks and issues in loan applications.
• Ensure all loan applications comply with company policies, investor requirements, and regulatory guidelines.
• Communicate with internal stakeholders and lenders to resolve issues and ensure timely processing of loan applications.
• Maintain up-to-date knowledge of mortgage products and underwriting guidelines for Conventional, FHA, VA, and other loan types.

Pre-Underwrite Reviewer

• Review and edit AI critique of writing samples using professional criteria
• Articulate evaluation methods for writing quality in your domain
• Participate in live workshops to explain edits

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