Davion Hall
Greenville,NC
Summary
Detail-oriented healthcare and insurance professional with 8+ years of experience supporting members and policyholders across insurance, healthcare, pharmacy, and financial services environments. Skilled in interpreting health plan coverage, reviewing and processing claims, navigating multiple systems, and meeting strict quality and production standards while supporting customer satisfaction and retention.
Overview
10
10
years of professional experience
Work History
Producer Services Representative (Insurance Claims & Coverage Support)
TTEC Solutions Inc.
11.2024 - Current
- Supported insurance producers with coverage, policy, and claims-related inquiries
- Reviewed plan and claim information to ensure accurate documentation and processing
- Utilized multiple systems to obtain, update, and record claim and member data
- Assisted with claim follow-up to support accurate payment outcomes
- Met quality, accuracy, and production benchmarks while supporting team goals
Customer Service & Collections Specialist
Transworld Systems Inc.
01.2024 - 03.2025
- Analyzed account and claim-related information to determine appropriate resolutions
- Negotiated payment arrangements in compliance with FDCPA regulations
- Identified discrepancies and escalated for follow-up when necessary
- Maintained accurate documentation while meeting productivity standards
Healthcare Claims & Member Support Representative
Everise
11.2022 - 02.2024
- Supported Humana CarePlus and Navitus Health Solutions members with eligibility and claims processing
- Reviewed claims to determine coverage, benefits, and appropriate next steps
- Coordinated with providers and pharmacies to resolve claim issues
- Maintained HIPAA compliance and detailed documentation
Insurance Claims & Coverage Support Representative
State Farm
01.2019 - 09.2022
- Provided coverage explanations and claims guidance via phone and email
- Documented policies, endorsements, and coverage changes in CRM systems
- Supported claim processing and payment-related inquiries
- Enhanced customer satisfaction through clear communication
Customer Service & Call Center Representative
Alorica
05.2016 - 01.2019
- Managed high-volume inbound calls in an insurance-focused environment
- Resolved escalated issues and processed account adjustments accurately
- Maintained data integrity and collaborated to meet service-level agreements
Education
High School Diploma -
Beddingfield High School
Wilson, NC06-2015
Skills
- Health Insurance Claims Processing
- Member Coverage & Eligibility Verification
- Claims Review & Payment Support
- Cost Management & Claim Escalation
- Multi-System Navigation
- CRM Documentation
- HIPAA Compliance
- Quality Assurance
- Analytical Thinking
- Attention to Detail
- Time Management
- Team Collaboration
- CRM & Claims Management Systems
- Member Eligibility & Benefits Platforms
- Dual-Screen Workflows
- HIPAA-Compliant Healthcare Systems
- Call Center & Ticketing Systems
Systems And Tools
- CRM & Claims Management Systems
- Member Eligibility & Benefits Platforms
- Dual-Screen Workflows
- HIPAA-Compliant Healthcare Systems
- Call Center & Ticketing Systems
Claims Processing Expertise
- Interpreting member health plan benefits and coverage guidelines
- Reviewing medical, pharmacy, and insurance claims for accuracy and completeness
- Supporting claim payment decisions based on policy provisions
- Identifying claim discrepancies and referring claims for follow-up or escalation
- Applying cost-containment awareness during claim review
- Processing claims within established quality and production benchmarks
Professional Highlights
- 8+ years supporting insurance and healthcare members in regulated environments
- Experience reviewing claims, coverage, and eligibility across multiple health plans
- Strong accuracy, documentation, and compliance performance in high-volume settings
- Proven ability to multitask across dual screens and multiple systems
Timeline
Producer Services Representative (Insurance Claims & Coverage Support)
TTEC Solutions Inc.
11.2024 - Current
Customer Service & Collections Specialist
Transworld Systems Inc.
01.2024 - 03.2025
Healthcare Claims & Member Support Representative
Everise
11.2022 - 02.2024
Insurance Claims & Coverage Support Representative
State Farm
01.2019 - 09.2022
Customer Service & Call Center Representative
Alorica
05.2016 - 01.2019
High School Diploma -
Beddingfield High School