Role Description As a Clinical Appeals Advocate, you will serve as a key patient advocate—supporting individuals who have been denied insurance coverage for Baxter’s Respiratory Health products. You will work directly with patients, healthcare teams, and insurance payers to overturn denials, secure access to medically necessary therapies, and advance our Mission to Save and Sustain Lives. This role requires strong clinical understanding, excellent communication skills, and the ability to navigate complex payer policies. You will collaborate cross‑functionally with Respiratory Health teams, build relationships with case managers and medical directors, and ensure a superior experience for patients throughout the appeals process. This is a remote position based in the United States. What you’ll be doing - Assess cases, develop appeal strategies, gather clinical documentation, and prepare persuasive appeal submissions for commercial and government payers. - Communicate with patients to explain appeal strategies, outline their responsibilities, and support preparation for hearings when applicable. - Create clinical case summaries and strengthen documentation for challenging payers or those with strict coverage criteria. - Process favorable appeal decisions promptly, negotiate payment rates through letters of agreement, and determine appropriate resolutions when denials are upheld. - Build and maintain professional relationships with case managers and medical directors to promote positive patient outcomes. - Deliver a superior customer experience by discussing payer policies, coverage criteria, benefit limitations, potential costs, and product information with patients and healthcare teams. - Ensure adherence to Hillrom and third‑party payer policies while maintaining high standards of quality, compliance, and team contribution. - Seek ongoing learning opportunities, support workload coverage, and perform additional duties or projects as assigned. Qualifications - Registered Nurse (RN), Respiratory Therapist (RT), or Licensed Practical Nurse (LPN) required, with active state licensure or certification. - Associate degree or higher, or equivalent work experience in a related clinical or reimbursement field. - Minimum of 3 years of experience reviewing medical records and securing third‑party reimbursement preferred. - Knowledge of federal, state, and local regulations, including HIPAA requirements and payer guidelines. - Exceptional written, verbal, and interpersonal communication skills with strong attention to detail. - Ability to multitask effectively, prioritize critical responsibilities, and manage time independently. - Strong critical‑thinking and problem‑solving abilities, with comfort working both independently and within a team. - Proficiency in Microsoft Office and related software tools. Requirements - Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment visa at this time. Benefits - Comprehensive compensation and benefits packages for eligible roles. - Health and well-being benefits including medical and dental coverage that start on day one. - Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance. - Employee Stock Purchase Plan (ESPP) with the ability to purchase company stock at a discount. - 401(k) Retirement Savings Plan (RSP) with options for employee contributions and company matching. - Flexible Spending Accounts and educational assistance programs. - Time-off benefits such as paid holidays and paid time off ranging from 20 to 35 days based on length of service. - Family and medical leaves of absence and paid parental leave. - Additional benefits including commuting benefits, the Employee Discount Program, the Employee Assistance Program (EAP), and childcare benefits.

• Serve as the main point of contact for assigned clients • Address client needs, resolve issues, and manage escalations promptly • Drive contract renewals and pursue cross-sell and upsell opportunities • Collaborate with internal departments to provide timely service • Maintain accurate client information in Salesforce

Role Description This is an opportunity to advocate for individuals in the position of Consumer & Employment Advocate which is both an internal and external facing role. - Consumer Advocate: - Ensure resolution of complex member issues, including the investigation, resolution, and communication of findings regarding escalated state cases and My Ombudsman referrals. - Support resolution of complex member inquiries while educating members/caregivers about their rights (i.e., grievance and appeal rights) within the scope of health plan benefits. - Analyze, investigate, and resolve member inquiries; My Ombudsman issues requiring coordination with members, providers, sister segments, and internal departments (such as clinical services, provider relations, and quality) as well as state regulators. - Assess, anticipate, and interpret enrollee needs and requirements; identify solutions to non-standard requests and problems and participate in process improvement activities as a response to feedback. - Develop relationships and collaborate with internal and external stakeholders (e.g., clinical teams, A&G, Call center, sister segments) to identify their needs and ensure proper delivery of our services/solutions, as needed. - Participate in efforts focused on medical, behavioral, and social determinants of health factors that improve the well-being of members and improve member satisfaction. - Support Advocacy team member engagement activities (e.g., Consumer Advisory Committee, surveys, focus groups, town halls) to elicit feedback to the health plan. - Provide mutual coverage and support to SCO plan Consumer Advocate. - Employment/Education Advocate: - Work with members (with complex physical, intellectual disabilities, behavioral health diagnoses, and/or SUD) on short-term interventions who are experiencing a variety of employment issues including needing assistance with resumes; access to job skills training programs and support them in self-advocacy goals. - Provide members with resources, interventions, and support in the community to find, preserve, maintain employment and address volunteerism and educational needs. - Provide leadership, guidance, and expertise as a consultant to plan staff clinical teams regarding topics including searching for employment; disability rights laws; reasonable accommodation; right to self-determination, etc. - Build, strengthen, and foster strategic connections (including referral pathways) with key community partners throughout the region with a focus on those that work with, employ, or connect low-income individuals and individuals with disabilities with employment and educational opportunities. - Recommend and work with clinical teams to refer members to other community supports (e.g., childcare, educational, mental health, substance abuse, domestic violence, legal and family services) that may support the member’s goals. - Overall Responsibilities: - Maintain responsive and respectful communication with staff, members, families, and community partners. - Use basic counseling skills of active listening, empathy, reflection, and validation. Act as an advocate to help members identify and pursue their identified goals. - Use recovery-oriented, person-centered, culturally competent, and strengths-based approaches to help members identify options. - Document work within electronic member record. Qualifications - 2+ years of experience working with individuals with BH/SUD diagnoses. - 1+ years of experience working with Medicaid programs. - Intermediate level of proficiency in Microsoft Office (Word, Excel, PowerPoint). - Willingness and ability to travel up to 10% within Massachusetts (for member engagement activities). Requirements - Professionally licensed clinician (i.e., LSW, LCSW, LICSW, LMHC) in MA. - Bilingual. - Experience working with Massachusetts Medicaid/Medicare programs. - Proven track record of building and maintaining community-based relationships. - Commitment to diversity, equity, and inclusion. - Presentation skills and ability to speak in front of diverse audiences (leadership, external entities, members, and providers) as well as facilitate a meeting. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements). - Salary range from $72,800 to $130,000 annually based on full-time employment.

CLX Pet Advocate Remote, United States | Claims Experience | Full-time Job Description: Not your everyday company Lemonade completely reinvented how insurance works. As a customer-centric tech company, we created an insurance experience that is smart, instant, and delightful. At Lemonade, you’ll be working with a group of like-minded makers, who get a kick out of moving fast and delivering great products. We surround ourselves with some of the smartest, most motivated, creative people who are filled with positive energy and good karma. Unlike most publicly traded companies, we’re nimble and efficient. We take pride in the fact that we still think and operate like a startup. We don’t care much about titles and hierarchy and instead focus on innovation, bold moves, and challenging the status quo. We’re built as a lean, data-driven organization that relies on a common understating of objectives and goals to provide teams with autonomy and ownership. We don’t like spending our days in meetings and we skip committees altogether. At Lemonade, there’s no such thing as going over someone’s head. We have zero tolerance for bureaucracy, office politics, and lean-back personalities. As a Public Benefit Corporation and a certified B-Corp, we deliver environmental and social impact using our products and tech. Through our Giveback program, we partner with organizations such as the ACLU, New Story, The Humane Society, Malala Fund, American Red Cross, 360.org, charity: water, and dozens of others, and have donated millions towards reforestation, education, animal rights, LGBTQ+ causes, access to water, and more. Awarded ‘best workplace’ Best Workplace and Best-Led Company by Inc. Magazine “World Changing” by Fast Company Recognized as a World Changing Idea by Fast Company Magazine Ranked #1 Home insurance in America Won best renters and homeowners insurance in America by US News, and others Best Pet Insurance in America Rated “Best Overall Pet Insurance” by Better Homes & Gardens Rated 4.9 on the App Store Among the highest rated apps of all time What you’re applying for CLX Pet Advocate What you're applying for We're looking for a sharp, empathetic claims professional to join our Pet Claims team and help the people (and pets) who need it most. In this role, you'll sit at the intersection of veterinary knowledge, insurance expertise, and customer care — reviewing complex pet medical claims and making fair, accurate decisions that genuinely matter to the families on the other side. We believe three things matter for every role at Lemonade: drive to push through challenges, efficiency that keeps standards high while moving fast, and adaptability that lets you pivot with data and AI insights. These aren't buzzwords, they're how we actually work. Our AI-first approach isn't just a tagline either. We're building the future of insurance with AI at the center, and we need people who are genuinely excited to learn and grow alongside these tools. In this role you'll - Navigate complex veterinary records and medical histories to determine claim eligibility and make accurate coverage decisions - Communicate coverage determinations clearly and directly — in plain language that customers actually understand - Document claim files thoroughly, grounding every decision in medical records and policy provisions - Organize and prioritize a daily workload to resolve claims quickly without cutting corners on quality - Request relevant missing information from customers or veterinary clinics in a timely manner to make claim decisions - Partner closely with CLX teammates to ensure every customer interaction reflects the care and clarity they deserve What you'll need - 5+ years of recent small animal vet tech experience; ER or specialty background strongly preferred - 1+ years in a CLX Specialist role (internal candidates only) - Prior pet claim handling or pet insurance experience, and existing P&C licensure strongly preferred - Ability to obtain and maintain P&C licensure - Excellent organization and prioritization skills - Strong written and verbal communication skills — you can break down complex decisions without hiding behind policy language - Genuine care for animals and the people who love them - Comfort with — and curiosity about — new technology, including AI tools that are central to how we work - A college degree - Ability to work in a remote environment Please note that we are unable to sponsor applicants for work visas. Unfortunately, we cannot consider applicants from these states: Alaska, California, Colorado, Montana, Hawaii, New Mexico and Puerto Rico. Lemonade's US base salary range for this full-time position is $60,000 - $70,000 plus equity + benefits. Our salary ranges are determined by role, level, and location. Within the range, individual pay is determined by work location and additional factors, including job-related skills, experience, and relevant education or training. Speak to your recruiter to hear more about the specific salary range for your preferred location. #LI-Remote Things to know… Lemonade is an equal opportunity employer committed to diversity and inclusivity. We never discriminate on the basis of race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status. If you require reasonable accommodations due to religious beliefs, pregnancy, or disabilities, let us know at any time.