Open to opportunities

Lydia Pranger

@lydiapranger

Message

Claims Representative focused on accurate processing, fast resolutions, and positive patient experiences.

United States

Message

What I'm looking for

I’m seeking my next career step with a highly respected healthcare organization where I can process claims accurately, resolve issues quickly, and keep improving the patient experience through careful research, clear communication, and teamwork.

I’m an experienced customer service and healthcare professional with 10+ years handling member needs, claim issues, and sensitive information. I’m known for dependable first-call resolution and for staying thorough when every case has a different problem to solve.

At UnitedHealthcare umr, I process claims per the member’s plan by researching each scenario, addressing denials, and coordinating next steps. I work through situations like claims needing pre-authorization, claims pended for security review (SIU), and cases denied by system status but reinstated after policy updates.

Previously, as a Customer Service Representative 2 at Elevance Health, I handled incoming chats/calls and resolved issues on the first interaction. I explained benefits and claim outcomes clearly, fixed claim processing errors by rekeying when needed, and contacted providers to secure authorization.

My background also includes direct patient support as a Nurse Assistant II, plus running and promoting skin care services as a Business Owner/Operator. I bring strong communication, medical terminology familiarity, and systems experience with EPIC and tools like iLead, facets, and member 360—always with an emphasis on continuous improvement and teamwork.

Experience

Work history, roles, and key accomplishments

Current

Claims Representative

Current

UnitedHealthcare UMR

Aug 2025 - Present (10 months)

Process health insurance claims per member plan rules, handling denials, pendings for further review, and approvals when policies have been reinstated. Investigate claim-specific issues and take appropriate next steps to complete adjudication.

Claims Adjudication Claims Denial Investigation Claims Pendings And Referrals Epic Systems Facets

Customer Service Representative 2

Elevance Health

Apr 2022 - Aug 2025 (3 years 4 months)

Answered incoming member calls and chats and resolved inquiries on the first interaction by explaining benefits and claim outcomes. Fixed claim issues by coordinating with providers for missing authorization and correcting claim processing errors as needed.

Live Chat Support First Call Resolution Benefits Claims Rekeying Customer Support

Business Owner/Operator

Skin Care Products/Services

Nov 2012 - Apr 2022 (9 years 5 months)

Operated a skin care business by creating ads, booking appointments, answering phones, and providing customer-focused service. Processed payments and handled issues quickly while coordinating with team members to meet service goals.

Customer Service Appointment Scheduling Phone And Customer Intake Ads Payment Processing Team Coordination Time Management

Nurse Assistant II

Barnes-Jewish Hospital

Apr 2009 - Jun 2010 (1 year 2 months)

Assisted patients with activities of daily living and followed daily assignments to support high-quality care on the unit. Worked with the care team, supported the RN as needed, and provided handoff reports to the oncoming nurse assistant.

Patient Care Support RN Assistance Patient Handoff Reporting

Sales Representative

Us Fidelis

Mar 2008 - Nov 2009 (1 year 8 months)

Supported sales team operations by participating in daily meetings, setting goals/incentives, and completing data entry tasks. Provided customer service, resolved client issues, transferred calls, and processed payment information.

Customer Service Data Entry Incentives client support