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    Insurance Investigation Proves Ideal Industry for CFE 

    Victoria Rodriguez, CFE

    Investigator 

    Texas Mutual Insurance 

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    Victoria Rodriguez, CFE, grew up surrounded by law enforcement influences. She always knew she wanted to help bring wrongdoers to justice and found her perfect fit not wearing a badge, but working in the special investigations unit of Texas Mutual Insurance. Even after a decade since obtaining her CFE credential, she still approaches each investigation with an open mind and adaptability to follow where the evidence takes her.


    How did you become passionate about fighting fraud?

    I grew up in El Paso, Texas. If you spent any time there, you know there is a military base and a large federal government presence. My family's background was in both, but most notably in law enforcement. My father, who was a police officer, and my mother, who worked in the dry-cleaning business, were strong influences in my life. They motivated me to ensure lawbreakers were held accountable, while understanding the importance of treating people with respect. My mother also instilled the value of providing excellent customer service.

    Wanting to follow in my family's footsteps, I knew I wanted to investigate, but I was looking for a position that didn’t require a badge and gun. I’ve found being a corporate insurance investigator to be the perfect fit, and the profession has evolved a great deal over the last decade. I feel fortunate to have attained my formal education and my El Paso street smarts before I started my career.

    What steps led you to your current position at Texas Mutual?

    While obtaining my masters in criminal justice, I organized a job fair on campus. As with most criminal justice programs, students naturally expect access to federal, state and local law enforcement employers. However, there was one nongovernmental entity that stood out to me at the job fair — Texas Mutual Insurance Company. I was inspired by how much emphasis the company placed on fraud prevention and investigation. The Texas Mutual representatives were confident about the company’s mission, which states it will provide a stable, competitive source of workers' compensation insurance for Texas employers. I knew little about the insurance industry, but I applied and was fortunate enough to interview alongside some of my fellow graduate students. I ended up getting the job and have been an investigator with Texas Mutual for more than 14 years.

    Do you face any unique challenges in insurance fraud?

    For insurance carriers, finding the balance between strong fraud investigations and excellent customer service is challenging, but essential. I believe our company does it the best — hands down. At Texas Mutual, there are three specialized units of investigators. I work in the premium fraud unit and my job is to investigate businesses that are defrauding the insurance company. Since we investigate our policyholders, it is incumbent upon my unit to ensure our findings are sound and that we show respect to the subjects of our investigations.

    What is one of the biggest lessons you have learned since entering the fraud prevention field?

    I work in an environment where auditors and investigators don’t always get a steady diet of truth. Auditors’ and investigators’ roles often intertwine, but it’s important to understand the distinction between the roles in the fraud examination process. The audit is often the largest part of a fraud investigation, and a big lesson I’ve learned is to obtain as much financial documentation as you can through the audit process, but then be prepared to look further. Keep asking questions, use different tools to get accurate information and pivot to where the evidence takes you.

    What is a memorable case or project that you have worked on; one that made you feel especially proud?

    Most of our premium fraud cases initiate from our audit department, usually when an auditor notices significant discrepancies in the insurance coverage and the client’s financials. Texas law requires employers to report all payroll and operations to their insurance companies and by misrepresenting payroll and operations, an employer can gain an unfair advantage over competitors. Our strongest fraud cases are submitted to prosecutors with evidence that shows fraud beyond a reasonable doubt.

    One of the cases that I’m most proud of I investigated just a couple years into my career. During an audit of a landscaping company, the auditor noticed the income-to-labor ratio was out of line with industry standards. The landscaping company said they subcontracted most of their work to an independent subcontractor; however the subcontractor was not truly independent. The investigation found that the subcontractor’s owner was also a dedicated supervisor of our policyholder, making the subcontractor essentially a payroll shell company. I worked closely with the local district attorney’s office on this case. It was my first time to testify in a criminal jury trial and I felt proud to say I was a CFE. Our investigative findings proved the company obtained workers’ compensation coverage through fraudulent means. The landscaping company was convicted of a first-degree felony.

    What do you like about being an ACFE member?

    This year marks my 10th anniversary as a CFE. Over the years, I have watched the CFE certification become the gold standard for fraud investigators. In 2017, I attended my first ACFE Global Fraud Conference. It was a great opportunity to engage with highly educated and dedicated professionals, and it was reassuring to know we’re all battling something, big or small, every day. I was glad to be part of a forum where law enforcement, corporate investigators and different industries could discuss experiences and share best practices. As with most ACFE training, the conference offered good tips that I could use at my desk on Monday morning.

    How has membership in the ACFE impacted your professional development?

    My involvement with the ACFE has been a positive influence in my career. I have fully enjoyed the benefits of the ACFE professional network. Today, I am a Chapter Leader/Training Director in New York, a member of the ACFE Higher Education Advisory Committee and a member of the ACFE Advisory Council.

    Over time, I’ve found the ACFE uniquely provides a professional platform that grows and evolves along with individual career paths. As my career changed and grew, so did my relationship with the ACFE. Throughout my career, regardless of my position, I have received training, networking, education and leadership opportunities from the ACFE.

    I went from working in the public sector as an investigator, to working at major banks in the private sector, to becoming a college professor. Yet I always found training, committees and networks in my particular area.

    What activities or hobbies do you like to do outside of work?

    When I'm not working, I spend my time with family and friends. Austin provides countless ways to have fun, and we spend lots of time outdoors, swimming, walking and enjoying the music scene.