Maria Rodriguez
Insurance Lawyer
Orlando,FL
Summary
Strategic Compliance and Insurance Law Executive with over 20 years of expertise in regulatory compliance, coverage and risk management. Demonstrated success in developing enterprise-wide compliance programs and navigating complex regulatory frameworks, with extensive litigation and counseling experience.
Overview
25
25
years of professional experience
Work History
Compliance Director
MCIC Vermont, LLC.
Orlando, FL
04.2022 - Current
- Developed and implemented comprehensive Compliance Program for Risk Retention Group serving major medical institutions.
- Conducted regulatory and legal analysis to ensure operational compliance across all functions.
- Executed thorough Compliance Risk Assessments to identify and mitigate compliance risks.
- Managed contracts, ensuring adherence to organizational standards and regulatory requirements.
- Reviewed and updated HIPAA and IT/IS policies for alignment with governing regulations.
- Established Governance, Risk, and Compliance (GRC) framework for Board approval.
- Collaborated in development of Enterprise Risk Management (ERM) and Own Risk Solvency Assessment (ORSA).
- Led projects including Contract Life Management (CLM), Master Regulatory Audit program, and NPDB reporting program.
Senior Director of Quality, Compliance and FWA
Heartland Fidelity Insurance Company
FL
01.2019 - 04.2022
- Company Overview: Pharmacies licensed as Non-Resident or Mail order Pharmacies nationwide; Pharmacy Benefit Manager (PBM) and Vision Benefit Manager/TPA operations also licensed in all states.
- Served as regulatory legal analysis resource for Florida and Pennsylvania Pharmacies licensed as Non-Resident or Mail order Pharmacies nationwide; Pharmacy Benefit Manager (PBM) and Vision Benefit Manager/TPA operations also licensed in all states.
- Lead a team of Compliance Managers and a Regulatory Paralegal.
- Established and oversaw comprehensive Fraud, Waste and Abuse programs in accordance with federal or state requirements.
- Performed annual compliance audits to evaluate compliance in claims, credentialing in accordance with NCQA standards, provider services and other operations. Required and oversaw corrective action plans implementations.
- Oversight of the licensing and delegated entities (FDRs) activities.
- Medicare and Medicaid Compliance and Audit management for 5 plus audits per year.
- Developed and annually reviewed compliance policies and procedures to ensure consistency with governing statutes, regulations and other guidance.
- Provided written and oral advice and guidance regarding compliance requirements that impacted the company’s products and business, including GDPR, as well as Virginia and California Data and Privacy Laws amongst other state consumer and data protection specific legislation.
- Developed and maintained robust auditing and monitoring tools and standardized forms.
- Identified areas of potential compliance risk and develop solutions for risk mitigation with Compliance Risk Assessment.
- Developed and provided E-training and education programs for the organization.
- Reported information to Compliance Committees and the Board of Directors.
- Pharmacies licensed as Non-Resident or Mail order Pharmacies nationwide; Pharmacy Benefit Manager (PBM) and Vision Benefit Manager/TPA operations also licensed in all states.
VP, Chief Compliance Officer & Corporate Secretary
Clear Blue Insurance Group
NC & PR
01.2016 - 01.2019
- Company Overview: Three size VIII, A- A.M. Best rated Property and Casualty carriers licensed in 49 States, plus DC, with authority to write all major lines of business; including home, auto, general, professional and contract liability, accident and health, disability, boiler and machinery.
- Prepared and implemented Compliance Charter. Chaired Compliance Board Committee.
- Accountable for designing and delivering appropriate, risk-based compliance policies and procedures and monitoring, auditing and training programs.
- Maintained current knowledge of laws and regulations, keeping abreast of recent changes.
- Developed the annual compliance and internal audit work plan, implementation of the compliance program in accordance with annual risk assessment (ORSA), including Anti-money laundering (AML) and OFAC matters.
- Developed, coordinated, and implemented multifaceted training programs that focused on the 7 elements as set by HHS/OIG.
- Independently investigated and acted on matters related to compliance, including internal investigations and any resulting corrective actions.
- Supervision of Forms and Rates revisions and filings, through SERFF and state-owned platforms.
- Lead all major compliance projects, including meeting compliance requirements for the acquisition and name change of an Indiana domiciled P & C carrier. Prepared all documentation, including Form A.
- Guided and counseled companies’ efforts for new proprietary and ISO based forms in all lines of businesses nationwide.
- Oversaw agent credential and appointment process through NAIC.
- Prepared and implemented SIU training in compliance with all state’s requirements, including Florida and California.
- Managed and responded Insurance Departments inquires and correspondence, including audits and complaints.
- Three size VIII, A- A.M. Best rated Property and Casualty carriers licensed in 49 States, plus DC, with authority to write all major lines of business; including home, auto, general, professional and contract liability, accident and health, disability, boiler and machinery.
Health Operations VP, Chief Compliance and Privacy Officer
MAPFRE Insurance Group
PR
01.2011 - 01.2015
- Company Overview: Health Operations VP, Chief Compliance and Privacy Officer.
- Developed Privacy & Health Compliance Program, including interactive dashboard.
- Chaired Compliance Board Committee.
- Oversaw implementation and adherence to policies, procedures, and the plan, including education, auditing and monitoring processes.
- Successfully implemented risk assessment proven by external means.
- Developed and performed Annual Audit plan for claims, eligibility, plan design and credentialing in accordance with NCQA standards, as well as other operations.
- Developed and implemented Health and Privacy web-based E-learning.
- Represented MAPFRE Life Health Operations, in the Legislative Matters Committee of Insurance Companies Association (ACODESE).
- Actively participated in reviewing health legislation drafts for open discussion in public hearings.
- Health Operations VP, Chief Compliance and Privacy Officer.
Corporate Attorney
PRAICO Insurance Company
PR
01.2011 - 01.2015
- Second to the General Counsel/Secretary and the Compliance Officer.
- Handled corporate legal affairs, including legal memorandum writing, contract reviewing and drafting, Health laws compliance matters, HIPAA regulatory counseling, as well as Medicare Secondary Payer (MSP) compliance reporting issues.
- In charge responses to Office of Insurance Commissioner (OCS) investigations and such, as well as other Regulator related matters.
- Developed and implemented HIPAA/Hitech E-learning tool.
Attorney
Private Practice
PR
01.2008 - 01.2011
- Committed to a one-on-one service, delivering corporate and individual clients on point meticulous legal opinions and representations, including employment legal expertise.
- Broad contract reviewing, drafting and negotiation involvement.
- Successfully argued Appeals Court cases.
- Settled in favor of 5 plaintiffs major employment case that changed how a major government agency contracts its workforce.
Education
Master of Laws - Insurance Law
University of Connecticut
Hartford, CTJuris Doctor Degree -
University of Puerto Rico School of Law
San Juan, PRMBA - Finance
Interamerican University of Puerto Rico
San Juan, PRMA - Criminal Justice
Interamerican University of Puerto Rico
San Juan, PRBA - Accounting, HR minor
University of Puerto Rico
Cayey, PRSkills
- Insurance coverage assessment
- Reinsurance management
- Insurance program analysis
- Regulatory liaison
- Project management
- Risk assessment
- Compliance development
- Legal research and analysis
- Policy formulation
- Leadership
- Contract negotiation
- Policy documentation
- Data privacy management
- Negotiation expertise
Certification
- Member of the Health Care Compliance Association, 01/01/12
- Certified in Healthcare Privacy Compliance (CHPC), 12/31/25
- Certified in Healthcare Compliance (CHC), 12/31/25
Timeline
Compliance Director
MCIC Vermont, LLC.
04.2022 - Current
Senior Director of Quality, Compliance and FWA
Heartland Fidelity Insurance Company
01.2019 - 04.2022
VP, Chief Compliance Officer & Corporate Secretary
Clear Blue Insurance Group
01.2016 - 01.2019
Health Operations VP, Chief Compliance and Privacy Officer
MAPFRE Insurance Group
01.2011 - 01.2015
Corporate Attorney
PRAICO Insurance Company
01.2011 - 01.2015
Attorney
Private Practice
01.2008 - 01.2011
Master of Laws - Insurance Law
University of Connecticut
Juris Doctor Degree -
University of Puerto Rico School of Law
MBA - Finance
Interamerican University of Puerto Rico
MA - Criminal Justice
Interamerican University of Puerto Rico
BA - Accounting, HR minor
University of Puerto Rico