Summary
Overview
Work History
Education
Skills
Languages
Strengths
Timeline
Generic

Felix A. Martez

Apopka,FL

Summary

Performance-driven Vice President and operations leader with 20+ years of experience aligning systems with business requirements, policies, and regulatory requirements. Passionate about applying excellent organization and communication skills to manage and lead teams. Results-oriented individual who cultivates strategic alliances and partnerships to positively influence corporate culture and achieve company goals. Well-versed in interfacing and consulting on business processes to drive results based on sound overall business judgment.

Overview

23
23
years of professional experience

Work History

Vice President, Provider Operations & Shared Services

Healthfirst
01.2018 - 12.2023
  • Lead all aspects of Provider Data Management Operations for New York's largest not-for-profit health insurer with a provider network consisting of >80 participating hospitals, >60K practitioners, >200K service locations, and >2K network facilities, serving >1.8M members living in New York City, Long Island, & Westchester, Sullivan, Orange, and Rockland counties, offering high-quality, affordable health plans, including Medicaid, Medicare Advantage, long-term care, and qualified health plans, as well as individual and small group plans
  • Achieved and/or exceeded company goals keeping expenses flat and/or reducing costs by ensuring team structure and operational capabilities were scalable with minimal impact to productivity and high-quality outcomes during multiple, rapid network growth initiatives resulting from mergers/acquisitions and territory expansions
  • Supplied strategic leadership and oversight of shared services functions, reducing expenses by 40% through centralization of internal auditing/quality assurance, learning delivery, and operational analytics
  • Collaborated with Learning Delivery Team on implementation of WalkMe with Salesforce and Workday platforms to increase digital adoption by end users and worked with enterprise IT Leadership to increase value of ServiceNow ticketing platform by expanding applicable business cases enabling us to reduce manual processes
  • Established and cultivated key relationships and partnerships to drive continuous improvements, reducing costs, rework, and increasing quality outcomes across the enterprise
  • Successfully lead multiple improvement/change initiatives ensuring prompt completion within budget for several high-volume production environments across multiple sites
  • Experience leading and managing exempt and non-exempt level teams, working within a matrix structure, driving cross-functional teams, and offshore, near-shore, and onshore third-party vendor management.

Assistant Vice President, Provider Operations & Services

Healthfirst
03.2015 - 01.2018
  • Responsible for the maintenance and accuracy of the provider database; including Physician Networks, Hospitals, Facilities, Provider Directories, Provider Credentialing, Contract enablement, & Claims Reimbursement configuration
  • Supported Provider Network team streamlining complaint identification, root cause analysis, and resolution
  • Coordinated cross-departmental meetings to execute company-wide initiatives
  • Conducted impact analysis and documented requirements in collaboration with IT for development
  • Aided in the company wide Six Sigma/Lean quality initiatives
  • Lead management team in candidate assessment and hiring process, skills development, writing, and conducting performance evaluations and terminations.

Director, Provider Operations & Services

Healthfirst
11.2011 - 03.2015
  • Lead all Provider Services Contact Center functions including resolution of Provider inquiries and/or complaints
  • Regularly coached team members and led meetings to drive improved results and recognize high performers
  • Established business direction for department/function/organizational unit(s); developed strategic, cost-effective programs, including system enhancements to improve competitive position
  • Developed, implemented, and ensured policy compliance for cross-departmental functions; reviewed performance reporting to show trends and plan accordingly
  • Led meetings as needed, presenting performance results and improvement plans to Executive Leadership

Manager, Provider Services

Healthfirst
07.2010 - 11.2011
  • Managed day-to-day operations of a high-volume customer contact center; analyzed call arrival patterns to develop better forecast models, implemented best in class workforce management methodologies
  • Coordinated hiring and training of new employees; created call quality assurance program, set team and individual KPI goals; implemented quarterly incentive bonus program
  • Conducted root cause analysis and implemented process improvements to resolve escalated issues per company policy and improved Provider satisfaction.

Director of Operations

InCharge Education Foundation, Inc, & InCharge Debt Solutions
02.2008 - 05.2010
  • Oversee national consumer enrollment in various personal finance education e-learning programs along with all operational components associated with running an efficient high volume inbound contact center
  • Responsible for quarterly publication of personal finance education magazine with distribution of 800K annually
  • Collaborated with Business Development Teams to support external client needs.

Manager of New Product Development & Strategic Partnership

InCharge Education Foundation, Inc, & InCharge Debt Solutions
05.2006 - 02.2008

Manager of Enrollment Counseling

InCharge Education Foundation, Inc, & InCharge Debt Solutions
01.2003 - 04.2006

Manager of Strategic Alliances

InCharge Education Foundation, Inc, & InCharge Debt Solutions
01.2002 - 12.2002

Manager of Client Services

InCharge Education Foundation, Inc, & InCharge Debt Solutions
01.2001 - 01.2002

Education

Healthfirst Voyager Program - Enterprise Leadership

Harvard Business Publishing Corp. Learning
New York, NY
07.2023

Associate of Arts - General Studies

State University of New York (SUNY): Suffolk Community College
Selden, NY
05.1993

Skills

  • Data Analysis
  • Organizational Skills
  • Customer Relationship Management
  • Process Improvement
  • Project Management
  • Resourceful
  • Budgeting and Forecasting
  • Creative
  • Vendor Management
  • Leadership Development
  • Change Management
  • Business Process Optimization
  • Operations Management
  • Conflict Resolution
  • Contract Negotiation
  • Performance Management
  • Innovation Management
  • Regulatory Compliance
  • Cross-functional Team Leadership
  • Team Building
  • Fluent in Spanish

Languages

English
Native or Bilingual
Spanish
Full Professional

Strengths

Inclusive and transparent collaborator who revitalizes underperforming operational teams to develop scalable and sustainable infrastructure aligned with industry best practices. Leverages integrity and highly tuned emotional intelligence to quickly build trust and gain buy-in. Values diversity and shows a genuine interest in helping others exceed expectations. Focuses on strengths and motivators to maximize individual and team productivity through ongoing engagement, coaching, and recognition. Authentic, well-respected collaborator; eager to lean in and lead by example. Proven track-record of identifying potential and developing those individuals for increased responsibility and career advancement. A positive optimist, who expects change and deploys change management initiatives in a manner that strikes an effective balance between people, process, and technology to achieve favorable outcomes.

Timeline

Vice President, Provider Operations & Shared Services

Healthfirst
01.2018 - 12.2023

Assistant Vice President, Provider Operations & Services

Healthfirst
03.2015 - 01.2018

Director, Provider Operations & Services

Healthfirst
11.2011 - 03.2015

Manager, Provider Services

Healthfirst
07.2010 - 11.2011

Director of Operations

InCharge Education Foundation, Inc, & InCharge Debt Solutions
02.2008 - 05.2010

Manager of New Product Development & Strategic Partnership

InCharge Education Foundation, Inc, & InCharge Debt Solutions
05.2006 - 02.2008

Manager of Enrollment Counseling

InCharge Education Foundation, Inc, & InCharge Debt Solutions
01.2003 - 04.2006

Manager of Strategic Alliances

InCharge Education Foundation, Inc, & InCharge Debt Solutions
01.2002 - 12.2002

Manager of Client Services

InCharge Education Foundation, Inc, & InCharge Debt Solutions
01.2001 - 01.2002

Healthfirst Voyager Program - Enterprise Leadership

Harvard Business Publishing Corp. Learning

Associate of Arts - General Studies

State University of New York (SUNY): Suffolk Community College
Felix A. Martez