The objective of this research was to develop a qualitative model for health governance and the prevention of conflicts of interest within the Social Security Organization. In this sector, conflicts of interest constitute a structural and multidimensional phenomenon—stemming from the organization’s multiple roles (insurer, purchaser of services, and direct service provider), the concentration of financial resources, and the complexity of decision-making processes—which existing mechanisms are unable to manage systematically. The study employed a mixed-methods approach with a sequential exploratory design. In the qualitative phase, data were collected through semi-structured interviews with experts and key stakeholders and analyzed using thematic analysis. In the quantitative phase, the extracted components were validated via the Delphi method over four rounds, involving 13 experts. Kendall’s coefficient of concordance reached 0.86 in the final rounds, and components with a mean score below 5 were excluded. The findings identified five overarching themes and eleven final components. The proposed model is designed as a multilayered, cyclical framework encompassing risk contexts and situations, preventive mechanisms (governance-related, structural, transparency-focused, supervisory, cultural, and educational), actors and responsibilities, implementation and oversight, as well as a feedback loop for continuous improvement. The results indicate that effective prevention requires simultaneous intervention at the structural, procedural, and cultural levels. The designed model can serve as a foundation for policymaking, process redesign, and the strengthening of oversight systems within the Social Security Organization; it may also contribute to reducing instances of conflict, improving the efficiency of resource allocation, and bolstering the trust of insured individuals.