Summary
Overview
Work History
Education
Skills
Languages
Timeline
Hi, I’m

Seema Sivajirao

Greater Sudbury,Canada

Summary

Results-driven professional with 4 years of experience in healthcare insurance operations, specializing in claims processing and appeals resolution. Currently excelling as a Shift Manager at KFC, showcasing exceptional leadership, problem-solving, and team management skills in a fast-paced environment. Actively pursuing a graduate certification in Business Analytics to enhance expertise in data analysis, reporting, and decision-making.

Overview

8
years of professional experience

Work History

KFC

Shift Manager
09.2023 - Current

Job overview

  • Trained and supervised new staff members
  • Balanced cash drawers and resolved financial discrepancies using receipts and financial documents
  • Addressed customer complaints and resolved conflicts

XL Health Corporation Pvt Ltd (United HealthGroups)

Appeals Representative Associate
09.2021 - 07.2023

Job overview

  • Responsible for providing expertise or general support to teams in reviewing, researching, investigating, negotiating, and resolving all appeals and grievances
  • Respond to expedited requests and solve routine problems by following established procedures
  • Analyze and identify trends for appeals and grievances

XL Health Corporation Pvt Ltd (United HealthGroups)

Claims Representative Associate
06.2019 - 08.2021

Job overview

  • Researched, identified, and obtained necessary data to process and resolve claims accurately, including verifying pricing, prior authorizations, and applicable benefits
  • Ensured proper benefits were applied to every claim while adhering to customer service requirements such as Service Level Agreements and performance guarantees
  • Identified and resolved claims processing errors/issues, including system configuration, eligibility, and vendor-related discrepancies, collaborating with internal and external stakeholders

#31 IT SOLUTIONS

Software Trainer
08.2017 - 04.2019

Job overview

  • Trained individuals and groups to effectively adapt to new computer applications and software programs
  • Planned, prepared, and researched lesson materials to ensure comprehensive training delivery

Education

Cambrian College of Arts and Technology

Business Analytics
07.2025

University Overview

Expected graduation July 2025

Cambrian College of Arts and Technology

Project Management
04.2024

Amrita School of Arts and Sciences

Master of Computer Application
05.2017

Skills

  • Python, SQL, R

  • Data Analysis

  • MS Office

  • Project Management

  • Problem Solving

  • Collaboration & Communication

  • Claims investigation

Languages

English

Timeline

Shift Manager

KFC
09.2023 - Current

Appeals Representative Associate

XL Health Corporation Pvt Ltd (United HealthGroups)
09.2021 - 07.2023

Claims Representative Associate

XL Health Corporation Pvt Ltd (United HealthGroups)
06.2019 - 08.2021

Software Trainer

#31 IT SOLUTIONS
08.2017 - 04.2019

Cambrian College of Arts and Technology

Project Management

Amrita School of Arts and Sciences

Master of Computer Application

Cambrian College of Arts and Technology

Business Analytics

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Seema Sivajirao