Full-Service Subrogation
Recover more from liable third parties with a healthcare subrogation solution that identifies opportunities earlier, validates liability faster, and helps maximize recoveries.
Turn discovery into stronger recovery
Subrogation performance depends on more than finding cases. You need the data, expertise, legal support, and operational discipline to validate liability, coordinate across stakeholders, and recover more value.
Carelon’s healthcare subrogation services help health plans identify, investigate, and recover claim payments when another party is financially responsible. We manage the end-to-end subrogation lifecycle through a flexible approach that connects advanced analytics, integrated workflows, carrier coordination, and legal expertise to improve financial outcomes while reducing the burden on your internal teams.
Lines of business:
- Commercial
- Medicare Advantage
- Medicaid
- Federal employee
Audience:
- Payers
Drive more value across the subrogation lifecycle
Connect identification, investigation, case management, and recovery in a more coordinated operating model to strengthen subrogation performance.
Find more opportunities earlier
Intelligent automation, data integration, and prioritization help surface subrogation opportunities sooner and focus effort where recovery potential is greatest.
Validate liability with greater confidence
Carelon combines investigation expertise, stakeholder engagement, and legal support to help confirm liability quickly and accurately.
Maximize recoveries with less operational burden
Integrated workflows, carrier coordination, and recovery expertise help plans capture more value while reducing the workload placed on internal teams and minimizing disruption for members and providers.
Built to seamlessly move cases from identification to recovery
Our capabilities connect the data, expertise, and workflows needed to keep cases moving through each stage of the recovery process.
Intelligent opportunity identification
Continuously surface potential subrogation cases using claims data, automation, predictive analytics, and indicators of third-party liability, helping reduce reliance on member questionnaires
Data integration and prioritization
Connect data sources for a clearer view of opportunities and prioritize cases based on recovery potential, complexity, and likelihood of success.
Investigation and liability validation
Investigate case facts, determine third-party responsibility, and validate recovery opportunities through structured workflows and stakeholder outreach.
Legal partnership and complex case support
Access integrated legal expertise for lien resolution, complex case management, plan language review, and recovery strategy.
Recovery management and reporting
Coordinate recovery activity across stakeholders while maintaining visibility into case status, recoveries, and program performance.
Proven recovery performance at scale
Carelon brings the experience, scale, and recovery discipline health plans need to improve subrogation performance across complex lines of business.1
How our subrogation services work
Identify potential cases
We use claims data, automation, predictive analytics, and liability indicators to uncover potential subrogation opportunities while reducing reliance on member questionnaires.
Prioritize recovery potential
We evaluate and prioritize cases based on available data, likely liability, recovery value, complexity, and required action.
Investigate and validate liability
We investigate case facts, validate third-party liability through structured workflows, and engage responsible parties.
Manage and coordinate recovery activity
We actively manage cases, protect recovery rights, and coordinate communication across health plans, members, providers, carriers, attorneys, and other stakeholders to keep cases moving toward recovery.
Recover and report results
We negotiate settlements, pursue reimbursement from available recovery sources, resolve liens and disputes, and provide reporting on recoveries, cycle time, and program performance.
Ready to recover more from liable third parties?
See how Carelon can help you uncover more recovery opportunities, strengthen subrogation performance, and reduce the operational burden on your teams.
Explore related subrogation solutions
Complete a questionnaire or refer a case
Use the tools below to complete a subrogation questionnaire, refer a new case, or access information about our healthcare subrogation process.
Questionnaire
Received a questionnaire in the mail?
Submit your information securely online or review other response options.
Case referral
Want to refer a new case to us?
Submit your information online and find additional options here.
Frequently asked questions about healthcare subrogation
Are you a health plan member seeking subrogation support?
Why did I receive a letter from Carelon about a subrogation questionnaire?
If you received a call, letter, email, or text from Carelon related to a subrogation questionnaire, we need additional information to determine if someone else should be financially responsible for your treatment.
For more information about a subrogation request, call the number listed on the subrogation letter you received.
You can also contact the Member Services number on your member ID card or use the member support contact information provided by your health plan.
1 Source: Carelon internal data, 2025.