Regular
Exempt
GENERAL DESCRIPTION:
Serves as a legal advisor and compliance leader for the Commercial Sales, Renewals, and Operations teams, ensuring adherence to state and federal regulations, risk mitigation, and effective governance across the commercial health insurance sales cycle, renewal processes, and related operations. Embedded within the Legal Department, the role partners with leadership to ensure regulatory compliance and support sustainable growth, driving operational excellence. Additional duties may be assigned as deemed appropriate by the Legal Department.
ESSENTIAL FUNCTIONS:
Provide support to the Request for Proposal Unit, Commercial Sales Department, and other operational areas by reviewing and developing responses to RFPs from current or potential commercial clients.
Support internal proposal development, including plan design, pricing strategies, and creation of new offers and value-added options to enhance competitiveness.
Guide operational areas in the development, approval, and implementation of commercial products, ensuring compliance and alignment with business objectives.
Review and advise on sales arrangements, presentations, proposals, and related materials to ensure adherence to state and federal regulations.
Guide structuring deals, commissions, and incentive programs within regulatory frameworks to mitigate risk.
Collaborate with Sales leadership to develop compliant strategies for client acquisition and retention.
Support the development and maintenance of documentation for the sales process and employer onboarding to ensure consistency and compliance.
Draft and update policies and procedures related to sales operations and client onboarding while monitoring regulatory changes and communicating impacts to internal stakeholders.
Post-Sale Service & Renewal Assist the Renewals and Service Department with account management, renewal processes, and related activities to drive client satisfaction and retention (post-sale service & renewal).
Assist in the administration of self-insured group contracts, Service Level Agreements (SLAs), RX rebate provisions, and reporting processes to maintain contractual compliance.
Identify potential risks in sales and operational practices and recommend effective mitigation strategies to protect the organization.
Partner with Underwriting, Marketing, and Customer Service to align operational processes with regulatory requirements, support audits, respond to regulator inquiries on sales practices and compliance, assist MCS General Insurance Agency operations, and contribute to drafting communications.
Must comply fully and consistently with all company policies and procedures, with local and federal laws, as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
MINIMUM QUALIFICATIONS:
Education and Experience: Bachelor's degree in Law, Business Administration, or a related field. At least five (5) years of experience in compliance, legal advisory, or regulatory operations within the health insurance industry, including experience supporting commercial sales and renewals. Strong knowledge of state and federal regulations governing health insurance products and sales practices is required.
Certifications / Licenses: Puerto Rico Licensed Attorney
Other: In-depth knowledge of insurance regulatory requirements in Puerto Rico.
Languages:
Spanish – Advanced (comprehensive, writing and verbal)
English – Advanced (comprehensive, writing and verbal)
"We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities."
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