Subrogation Referral Reviewer

Once a claim is paid, money the insurer is entitled to recover often walks out the door - because no one read the file in time to see that a third party caused the loss. A subrogation analyst has to comb each closed claim for a liable party, a workable theory of liability, and a statute-of-limitations clock that is already running, and high-volume desks simply cannot review every file the same way. Recoverable dollars get written off and deadlines quietly expire. This assistant reads each claim file against your subrogation criteria, calls whether recovery potential is strong, possible, or none, names the likely liable third party and the basis, rates referral priority against the deadline and recoverable amount, and drafts a reviewer note the analyst can act on. A backlog of closed claims becomes a triaged referral list in minutes - and the analyst confirms, adjusts, or overrides every call before a file is referred or closed.

Category: Finance

How it works

1. A subrogation analyst or claims adjuster submits the claim file - the loss description, adjuster notes, payment summary, and any reports (police, fire, or expert).
2. The assistant reads the file against your subrogation criteria, isolating the cause of loss, any third party that may share fault, the theory of liability, and the statute-of-limitations window.
3. It calls subrogation potential as strong, possible, or none, names the likely liable party and basis, rates referral priority against the deadline and recoverable amount, and lists the evidence still needed.
4. It hands the assessment to the analyst to verify, adjust, and approve - nothing is referred, waived, or closed automatically.

Key benefits

• Catch recoverable dollars and a running statute-of-limitations clock while the file is still open - not after the deadline quietly expires and the loss is written off
• Review every closed claim the same disciplined way against your criteria, instead of relying on which adjuster had time and which files happened to get a second look
• Turn a backlog of paid claims into a prioritized referral list in minutes, so strong recovery files move to the subrogation team and dead ends close cleanly
• Keep a clear, file-cited record of why each claim was referred or waived - useful for recovery audits, reinsurance reporting, and adjuster oversight

Use cases

• Subrogation and recovery analysts triaging a backlog of paid claims to find files worth pursuing before deadlines lapse
• Claims adjusters at insurers and TPAs who need a consistent subrogation screen on every closed file, not just the obvious ones
• Recovery and SIU managers who want an audit trail showing why each claim was referred or waived
• Self-insured employers and risk pools standardizing subrogation review against a written recovery checklist

Good to know

No external connection - your claim files, adjuster notes, and loss data stay in your workspace. The assistant evaluates each file against the subrogation criteria you provide and drafts a potential call, priority rating, and reviewer note, but it works only from what is in the file - it does not replace your recovery counsel or claims policy, and it does not refer, waive, or close anything. The analyst approves, adjusts, or overrides every call before any file moves; nothing is decided automatically.

Frequently asked questions

How does the Subrogation Referral Reviewer work?

You submit a claim file with loss details, adjuster notes, and payment summary; the assistant reads it against your subrogation criteria to identify a liable third party, theory of liability, and statute-of-limitations deadline, then rates recovery potential as strong, possible, or none and drafts a reviewer note for the analyst to act on.

Do I need to write code to use this?

No, it works entirely within Gaia's no-code platform-you just provide the claim file and your subrogation criteria, and the assistant does the analysis without any programming.

Does it automatically refer or close claims?

No, it never auto-sends or auto-closes anything; the assistant drafts an assessment and priority rating, but a human analyst must verify, adjust, and approve every call before a file is referred or waived.

Which apps does it connect to?

It does not connect to any external apps-your claim files, adjuster notes, and loss data stay within your Gaia workspace, and the assistant evaluates them based on the criteria you provide.

How accurate is the subrogation potential rating?

It rates potential as strong, possible, or none based solely on the information in the claim file and your criteria, but it does not replace legal counsel or claims policy; the analyst always reviews and overrides if needed.