Compliance & Privacy Officer - TSP

When you join Grupo Triple S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.

• Oversee and monitor the implementation of the Compliance Program;

• Ensures that compliance status reports are provided regularly to the Compliance Vice President. Reports should include the status of the compliance program implementation, the identification and resolution of suspected, detected or reported instances of noncompliance, and the Organization’s compliance oversight and reviews, internal and external;

• Chair the Executive Compliance Committee;

• Submit recommendations to the Compliance Vice President to modify and amend the Compliance

• Program as appropriate to reflect changes in applicable laws and regulations and changes in the scope of the business. Aware of daily business activity by interacting with the operational units of the Organization
• Creating and coordinating, by appropriate delegation, if desired, educational training programs to ensure that the organization’s officers, governing body, managers, employees, subcontractors are knowledgeable about the Organization’s compliance program, its written Code of Conduct, compliance policies and procedures, and all applicable statutory and regulatory requirements;

• Developing and implementing methods and programs that encourage managers and employees to report noncompliance and potential FWA without fear of retaliation;

• Maintaining the compliance reporting mechanism and closely coordinating with the internal audit department, as applicable;

• Responding to reports of potential FWA, including the conducting or coordinating internal investigations with internal audit, human resources or legal departments and the development of appropriate corrective or disciplinary actions, if necessary;

• Maintaining documentation for each report of potential noncompliance or potential FWA received from any source, through any reporting method (e.g., hotline, mail, or in-person);

• Overseeing the development and monitoring of the implementation of corrective action plans;

• Direct the process to receive, analyze, respond and record the inquiries received from employees, customers or regulatory agencies;

• Advise management of establishing systems to comply with new laws, whether federal or state and any requirements of the Office of the Commissioner of Insurance, CMS, BCBS, and others;

• Participate in the development of policies, standards, procedures, and controls aimed at regulating operational activities for which they are conducted within the highest ethical standards and in compliance with the laws regulating the business.

• Prepares reports of findings identifying errors, vulnerable areas or areas of risk identified in internal audits and presents to management with recommendation of necessary changes to existing processes.

• Responsible for maintaining communication with the Office of Anti-fraud, the Office of the Commissioner of Insurance, and CMS. Prepare publications and various forms of communications to raise awareness of compliance requirements and standards

• Ensures that internal financial controls are implemented as designed and kept up to date, and resolve any comments related to internal controls on time.

• Responsible for the implementation, monitoring and reporting issues regarding the privacy of personally identifiable information (PII) to the management and applicable external entities and agencies;

• Work closely with Information Technology, business personnel, legal, risk management and other personnel on implementation and enforcement of compliance requirements;;

• Support compliance risk management programmer, by coordinating various projects, monitoring, and reporting status, supporting project risks and issues management;

• Support investigations of alleged violations of the laws or regulations and evaluate conduct compliance assessments to identify gaps, impacts and risks

• Bachelor’s Degree
• Preferably a Juris Doctor in Law from a recognized University in Puerto Rico or United States
• Minimum 5 years of related experience, preferably in the insurance industry
• Advanced level of communication skills (spoken and written) in Spanish and English
• Customer service oriented
• Knowledge in computer systems (hardware and software), Microsoft Office and other applications
• Knowledge of state and federal laws, legal codes, court procedures, precedents, and government regulations, etc.