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Subrogation for health plans

Identify, investigate, recover and prevent inaccurate payments linked to accident-related medical and disability expenses.

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Identify incorrect payments on accident-related claims

Identifying and recovering inaccurate payments on accident-related claims while respecting member sensitivity can be challenging. Optum® Subrogation services combine pre- and post-payment processes to help you identify, recover and prevent unnecessary payment of third-party claims.

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A member-sensitive approach to subrogation

Our Subrogation solution automates and streamlines the identification, investigation, recovery and prevention of high-potential claims.

Score claims with our robust analytic engine

Our 2.5K rules prioritize claims by recovery potential. Machine learning models use this data to update rules and reduce false positives.

Automate claim investigation

Claims are then matched against national and state litigation and injury databases to identify liable parties and limit member outreach.

Optimize member outreach

Advanced predictive analytics determine the best channel to engage members, when needed.

Leverage legal and operational expertise

Dedicated support is provided from the start to help with case management, member outreach, legal expertise, recovery, reporting and more.

Maximize savings with Pre-Pay Subrogation services

By combining pre- and post-pay subrogation processes, health plans can avoid unnecessary payment of third-party claims while minimizing member abrasion.

Our experts investigate and pursue potential accident claims before payment. We verify other coverage and provide the necessary information for the primary carrier to accurately pay the claim.

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Partner with the largest provider of health care subrogation

With more than 35 years of experience, we provide subrogation and recovery services in all 50 states and internationally, generating nearly $1 billion in annual recoveries for health plans. Our results:

  • $5–15 PMPY (per member, per year) estimated post-pay savings
  • Additional $3–9 PMPY estimated savings when Pre-Pay Subrogation is added to existing post-pay program
  • 66% fewer member touches

Prevent and recover accident-related claim payments with our pre- and post-pay Subrogation services