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RIYAN ALI
Mumbai
Work Preference
Summary
Detail-oriented Insurance Claims and Policy Processing Specialist with 6 years of experience in claim analysis and policy navigation. Skilled in problem-solving and fostering effective communication among stakeholders. Delivers high-quality results through collaborative efforts and strong analytical capabilities.
Overview
1
1
Certification
6
6
years of professional experience
Work History
Insurance Specialist
Marsh McLennan
Mumbai
09.2025 - Current
- Managed the First Notice of Loss (FNOL) process by getting new claims entered quickly and assigning them to specific adjusters based on the nature of the claim.
- Processed a heavy caseload of incoming claims, catching documentation errors early and making sure everything met strict policy guidelines..
- Finalized payments for valid claims and escalated complex cases to the appropriate team for additional review.
- Collaborated with claimants and healthcare partners to resolve paperwork discrepancies quickly and gather necessary info for accurate processing.
- Investigated suspicious claims, documenting findings and escalating concerns to management.
- Tracked and summarized ongoing claim activity, creating detailed reports that ensured management team was informed of all developments.
- Managed a highly diverse portfolio of claims, balancing high-volume bulk processing with detailed reviews for both professional and individual policyholders.
- Conducted line-by-line reviews of complete policy documents to spot and fix mistakes, making sure all coverage info was perfectly accurate for the policyholder.
- Assisted with major data migration project, moving and updating legacy policy and claim files into company’s upgraded software system to improve data accessibility.
Claims Associate
Allstate Insurance
Pune
01.2023 - 07.2025
- Managed end-to-end bodily injury liability claims, ensuring thorough analysis of FNOLs, policy coverage, and liability determination.
- Approved and processed payments up to $10,000 in compliance with Allstate and regulatory policies.
- Ensured compliance with HIPAA guidelines throughout the claims lifecycle.
- Managed inbound and outbound calls to facilitate information gathering and communication among adjusters, healthcare providers, and claimants.
- Coordinated with healthcare providers for retrieval of medical records and billing documents.
- Liaised with the subrogation department to gather lien documentation and verify third-party coverage.
- Maintained detailed collateral sheets to log medical bills, payments, and liens for audit readiness.
- Collaborated with internal teams to allocate tasks, update workflows, and train peers effectively.
- Collaborated with teams to enhance customer service processes and strategies.
- Recommended process enhancements that streamlined operations and improved overall efficiency.
- Supported project management by coordinating cross-functional team efforts.
Process Associate
Tata Consultancy Services (TCS – AVIVA UK Insurance)
Nagpur
01.2022 - 01.2023
- Verified claim details against policy terms, ensuring compliance with deductibles, limits, and stated exclusions.
- Double-checked that every system update and document change was fully audit-ready and strictly followed Company internal guidelines and UK compliance regulations.
- Acted as the primary contact for attorneys and customers via phone and email, securely sharing sensitive policy documents, T&Cs, and bond/share statements.
- Organized claim and policy data in company system, routinely updating client documentation to ensure accuracy and completeness.
Operations Analyst
Concentrix Daksh
Pune
10.2020 - 01.2022
- Handled subrogation calls for UnitedHealthcare, creating event numbers for streamlined claim tracking.
- Managed inbound calls from insurance companies, resolving subrogation queries and providing timely claim status updates.
- Logged claim details with high accuracy while ensuring HIPAA compliance.
- Maintained detailed documentation of support cases to facilitate effective follow-up.
Education
Bachelor of Commerce (B.Com) -
Skills
- P&C claims management
- FNOL intake review
- Claim processing
- Policy review
- Insurance Regulatory Compliance
- Subrogation Liaison & Lien Documentation Support
- Third-Party Liability Coordination
- Medical Billing Review
- Dispute Resolution & Claimant Support
- Claims platforms
- Data management
- System Data Migration & Record Management
- Reporting analytics
- Software systems
Certification
- AIDA Level 1 & Level 2 – Property & Casualty Insurance Fundamentals
- Excel Advanced – Pivot Tables, Lookup, Conditional Formatting
- HIPAA Awareness & Compliance Training
- Lean Six Sigma Yellow Belt Certification
Achievements
- Achieved 180% productivity with 100% accuracy, earning the Mountain Mover and Rising Star awards for high-volume claims delivery.
- Implemented process improvements through Root Cause Problem Solving (RCPS), reducing Average Handling Time by 15 minutes per case by optimizing TPL vendor reporting and minimizing call dependency.
- Worked on FMEA (Failure Modes and Effects Analysis) to identify process risks and enhance claims handling efficiency, for which I was honored with the Mountain Mover Award for outstanding contribution to process improvement.
- Supported a large-scale data migration project, accurately transferring and updating legacy policy and claim files into newer application systems.
- Contributed to team work allocation, maintained huddle boards, managed the leave tracker, and successfully rolled out a timesheet implementation to support overall team operations and productivity.
Additional Information
- Languages: English, Hindi
Timeline
Insurance Specialist
Marsh McLennan
09.2025 - Current
Claims Associate
Allstate Insurance
01.2023 - 07.2025
Process Associate
Tata Consultancy Services (TCS – AVIVA UK Insurance)
01.2022 - 01.2023
Operations Analyst
Concentrix Daksh
10.2020 - 01.2022