Robert E. Diaz
Alpharetta,GA
Summary
Experienced leader with a proven track record in strategic planning and driving organizational growth. Prepared to take on a senior management role, leveraging expertise in fostering team collaboration and delivering results through effective leadership and adaptability. Strong project management, decision-making, and communication skills consistently contribute to successful outcomes. Recognized for reliability and the ability to navigate changing environments with ease.
Overview
34
34
years of professional experience
1
1
Certification
Work History
Commercial & Specialty Division Chief Compliance Officer
Elevance Health, Inc.
01.2023 - Current
- Chief Compliance Officer for largest business unit, Commercial and Specialty Business Division (CSBD), including Large & Small Group fully insured, ASO, Individual/ACA, Dental, Vision, Third Party Administrator
- Assure comprehensive and effective compliance support for all 14 Blue Cross health plans, including monitoring and oversight of delegated entities, support and facilitation for all market conduct examinations, operations oversight, regulatory guidance and support
- Develop and execute comprehensive and effective compliance programs for all CSBD companies/lines of business.
- Completed reorganization and realignment of largest compliance team to drive improved results, better alignment to business objectives, budget efficiencies and more effective compliance programs across all CSBD.
- Significant YOY reduction of regulatory fines, penalties, and repeat findings in Market Conduct Exams.
Carelon Global Svcs Compliance & Privacy Officer
Elevance Health, Inc.
01.2017 - Current
- Chief Compliance and Privacy Officer for fast growing Global Capabilities and In-House Center with over 15,000 employees and locations in Israel, India, Ireland, Puerto Rico and Philippines
- Develop and execute fit for purpose Compliance program global business including training and communications, third party due diligence, anti-bribery/corruption, FCPA monitoring and oversight as well as compliance with all applicable local country laws and regulations.
- Close collaboration with Country Heads to drive highly effective, culturally relevant Culture of Compliance and assure effective internal controls, strong 'tone at the top' in alignment with DOJ Compliance Program Evaluation Guidelines
Medicaid Chief Compliance Officer
Elevance Health, Inc.
01.2015 - 01.2023
- Chief Compliance officer for dynamic, fast-paced and growth-oriented Medicaid Business Unit of leading, national health insurer
- Provide Executive Leadership for Compliance and Regulatory Services Team of over 150 associates located across 26 states
- Reduced fines and penalties by over 50% year over year from 2016 – 2020
- Responsible for execution of comprehensive and effective Compliance and Issue Management Program in highly regulated segment of healthcare industry
- Responsible for Regulatory Reporting for Commercial, Medicare and Medicaid lines of business
- Responsible for licensing and holding company filings across all lines of business
Interim, Enterprise Chief Compliance Officer
Elevance Health, Inc.
08.2021 - 05.2022
- Interim Chief Compliance Officer responsible for implementation and monitoring of effectiveness of Anthem’s Ethics, Compliance and Privacy programs and strategy
- Oversee all Ethics, Compliance and Privacy functions for Company, subsidiaries and affiliates including Commercial, Exchange, Medicare, Medicaid
- Direct engagement with Board and business leadership to drive a culture of compliance and accountability
- Deliver Compliance Training to the Board and provide quarterly updates to the Audit Committee, CEO and executive leadership on material risks, issues, and strategic priorities
Chief Compliance Officer, Privacy Officer
Alere Toxicology Services, Inc.
01.2012 - 01.2014
- Company Overview: Compliance Officer for a leading, $3.0B+ toxicology company (pre-Abbott acquisition) providing testing solutions to a wide variety of industries including employers, government agencies, occupational health clinics, managed care organizations, pain management practitioners, physician offices and substance rehabilitation centers
- Manage and oversee a team of 75 employees, including Compliance Department, Field Service Representatives and Compliance Training & Education Department
- Develop, implement and maintain Corporate Compliance Program including but not limited to policies and procedures, Compliance Hotline, auditing and monitoring, compliance training and education and internal investigations to detect, mitigate and/or prevent illegal, unethical, or improper conduct
- Develop and execute Annual Compliance Work Plan based on internal risk assessments, OIG guidance, state and federal requirements, relevant contractual obligations, and industry trends to ensure ongoing organizational compliance
- Provide relevant guidance to identify and create awareness concerning critical compliance concerns including but not limited to Federal and State Anti-Kickback Laws, Stark Law, Fraud, Waste and Abuse, Medicare/Medicaid billing, False Claims Act, HIPAA, Foreign Corrupt Practices Act, Patient Billing
- Provide Compliance Program Effectiveness reports to Audit Committee and Senior Management on a regular basis, and as directed or requested
- Compliance Officer for a leading, $3.0B+ toxicology company (pre-Abbott acquisition) providing testing solutions to a wide variety of industries including employers, government agencies, occupational health clinics, managed care organizations, pain management practitioners, physician offices and substance rehabilitation centers
Division Vice President, Regulatory Affairs
WellCare Health Plans, Inc.
01.2005 - 01.2012
- Key member of Florida & Hawai’i Division Senior Management Team repositioning the company to improve relationships with regulatory agencies and other key external stakeholders
- Lead all regulatory affairs and compliance activities for Florida/Hawai’i Division focusing on Medicaid, Medicare and SCHIP programs
- Direct report to Division President with oversight of regulatory affairs, operations compliance, quality improvement and government relations activities in Florida
- Dotted-line report to General Counsel and Chief Compliance Officer for all legal and compliance matters
- Led a team of 15 associates through four direct reports including Florida Director of Regulatory Affairs, Hawaii Director of Regulatory Affairs, and Florida Senior Director of Government Affairs
- Achievement: Significantly improved compliance oversight and monitoring in Florida and Hawai’i markets contributing directly to successful expansion and increased revenue in both markets
Second Vice President & Assistant General Counsel, Corporate Legal Department
Swiss Re Life & Health America Inc.
01.2004 - 01.2005
- Provided counsel and assistance to LTC and HHC reinsurance actuarial units with respect to various insurance regulatory matters including rate increases, reinsurance policies, holding company filings
- Reviewed and provided counsel with respect to confidentiality and non-disclosure agreements and vendor contracting issues involving claims administrators and other TPAs
- Provided counsel to human resources unit with respect to employee benefit coverage issues and disputes, including ERISA, COBRA and employee benefit issues
- Provided counsel and assistance with respect to liability issues involved with reinsured carrier market conduct examinations, regulatory investigations and settlements
Compliance Director, American Travelers Assurance Company, Corporate Secretary
HealthMarket Inc.
01.2001 - 01.2004
- Led development and execution of HealthMarket's Regulatory Compliance Department activities and direct report to both General Counsel and CEO
- Responsible for developing and maintaining HealthMarket's external relationships with elected and appointed state officials to ensure representation of the company's position on key issues
- Functioned as Privacy and Corporate Compliance Officer and managed all aspects of corporate compliance and privacy programs including development and maintenance of written policies and procedures, development and implementation of compliance program, compliance communications, training, issue monitoring, risk analysis and mitigation
- Led all regulatory and compliance activities for licensed entities in 38 states, including Georgia, Texas, Ohio, Illinois, Florida, Connecticut, New York, Missouri and District of Columbia
- Served as the central point of contact for associates, customers and vendors regarding the interpretation and application of relevant laws, regulations, health care industry standards, and corporate policies and procedures
- Retained and managed outside counsel, lobbyists and other consultants on relevant matters and participated in the management of those resources
- Provided quarterly reports to Board on key compliance metrics, risks and related indicators
Managing Director, Benefits and Regulatory Compliance Department
Emblem Health
01.1997 - 01.2001
- Lead corporate liaison with New York, New Jersey, Pennsylvania and Florida Departments of Insurance for approval of all HIP Health Plans and HIP Insurance Company products and programs, including managed Medicaid and SCHIP products
- Provided legal and regulatory counsel to Underwriting and Actuarial Departments regarding all state and federal regulatory requirements
- Liaison with the Office of Personnel Management ('OPM') for company's participation in the Federal Employee Health Benefits Program, including review of annual benefits proposal, negotiations with OPM on new plan benefits and consultation regarding new initiatives
- Monitored and analyzed legislative trends, government initiatives and promulgation of new regulations
- Responsible for implementing business process changes resulting from new laws or regulations
- Development and maintenance of compliance dashboard comprised of key performance indicators and reported findings to Senior Management
Associate Counsel, Legal Department
Empire Blue Cross Blue Shield
01.1996 - 01.1997
Counsel, Legal and Government Affairs Department
CIGNA Corporation
01.1993 - 01.1996
Associate Attorney, Litigation Department
Cummings & Lockwood
01.1991 - 01.1993
Education
J.D. - Law
Fordham University School of Law
Skills
- Team leadership
- Project management
- Strategic planning
- Operations oversight
- Budget management
- Risk management
- Change management
- Compliance management
Accomplishments
- Promoted to develop and implement a national strategy for enterprise-wide compliance initiatives, programs, and processes through technology, leading to significant program maturity improvements.
- Optimized center of expertise shared service units for issue and risk management, regulatory reporting, licensing filings, and applications, ensuring operational processes delivered with speed, accuracy, and quality.
- Enhanced reporting and data analytics capabilities, producing robust, comprehensive data driven reports that increased transparency and visibility.
- Measured and reported program effectiveness, identifying opportunities for incremental improvement, elevating program maturity and awareness, and establishing outcome-driven, value-based performance metrics for continuous improvement.
- Built and executed offshore strategies to identify efficiencies and leverage Carelon Global Services, contributing to operational enhancements and cost savings, while ensuring strict adherence to offshoring prohibitions.
- Standardized monitoring and reporting processes, including risk management, regulatory alerts/exams, regulatory mandates, and compliance plans, ensuring cohesiveness across the enterprise.
Affiliations
- Member, Connecticut Bar Association
Certification
Health Care Compliance Association
Languages
Spanish
Native or Bilingual
Timeline
Commercial & Specialty Division Chief Compliance Officer
Elevance Health, Inc.
01.2023 - Current
Interim, Enterprise Chief Compliance Officer
Elevance Health, Inc.
08.2021 - 05.2022
Carelon Global Svcs Compliance & Privacy Officer
Elevance Health, Inc.
01.2017 - Current
Medicaid Chief Compliance Officer
Elevance Health, Inc.
01.2015 - 01.2023
Chief Compliance Officer, Privacy Officer
Alere Toxicology Services, Inc.
01.2012 - 01.2014
Division Vice President, Regulatory Affairs
WellCare Health Plans, Inc.
01.2005 - 01.2012
Second Vice President & Assistant General Counsel, Corporate Legal Department
Swiss Re Life & Health America Inc.
01.2004 - 01.2005
Compliance Director, American Travelers Assurance Company, Corporate Secretary
HealthMarket Inc.
01.2001 - 01.2004
Managing Director, Benefits and Regulatory Compliance Department
Emblem Health
01.1997 - 01.2001
Associate Counsel, Legal Department
Empire Blue Cross Blue Shield
01.1996 - 01.1997
Counsel, Legal and Government Affairs Department
CIGNA Corporation
01.1993 - 01.1996
Associate Attorney, Litigation Department
Cummings & Lockwood
01.1991 - 01.1993
Health Care Compliance Association
J.D. - Law
Fordham University School of Law
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