Subrogation excellence: Gaining an edge with a compliance-focused approach
A compliance-focused mindset can help transform subrogation into a strategic advantage. It requires establishing a strong regulatory and ethical foundation from the outset. By prioritizing compliance, health plans can secure efficient recoveries while minimizing risk, provide clear guardrails to support innovation, protect organizational reputation, and maintain the trust of stakeholders.
Measuring subrogation success
Many subrogation programs measure success in dollars recovered. But what if that tells only half the story? True excellence lies in how those recoveries are achieved. A program that delivers high returns but cuts corners on compliance, transparency, or member experience risks eroding trust. Once that trust is lost, it becomes harder to regain. That’s why it is essential that regulatory alignment and ethical rigor is embedded throughout a subrogation strategy. In doing so, recovery is accelerated through:
- Built-in data security.
- Proactive quality oversight to help prevent errors.
- Peace of mind that recoveries enhance both financial performance and the organization’s reputation.
The benefits of a compliance-focused approach
Health plan leaders and third-party administrators (TPAs) must work to meet the demands of today’s highly scrutinized environment. The strongest subrogation solutions align with evolving regulations, industry standards, and member expectations for privacy and fairness. Additionally, they create competitive advantage that not only protects organizational reputation but also enhances operational resilience.
When a subrogation system is focused on compliance:
- Health plans become more agile, adapting quicker to regulatory changes and avoiding costly disruptions.
- A valuable opportunity to strengthen the trust of internal stakeholders, external partners, and members is uncovered by consistently prioritizing integrity.
- Internal teams can confidently adopt new technologies and refine processes without fear of introducing risk.
- Advanced analytics, real-time reporting, and flexible member communication thrive in an environment where compliance principles are non-negotiable.
Essential elements of a compliance-focused model
Carelon has more than 30 years of subrogation expertise working with an array of diverse health plans and TPAs and manages more than 50 million members. We’ve uncovered key patterns that define a truly compliance-focused model. These characteristics include:
- Meticulous oversight including structured audits, layered quality control, and detailed case reviews.
- Embedded security that aligns with top-tier industry standards such as HITRUST certification.
- Independent monitoring by quality and compliance teams for unbiased process evaluation.
- Clear, consistent policies that guide decision-making and support operational predictability.
- Technology-enabled identification that spots recovery opportunities earlier and more accurately.
- Transparent stakeholder communication to keep stakeholders informed and aligned.
By treating these elements as cultural norms rather than compliance tasks, health plans can achieve sustainable recoveries without compromising integrity.
Laying the foundation for long-term subrogation success
A compliance-focused subrogation program can deliver measurable recoveries. More importantly, it can help safeguard the relationships and reputation crucial for long-term success. When implemented strategically, compliance helps establish the groundwork for efficiency, adaptability, innovation, and sustained trust.
