Operate, actions

Actions

Downstream actions derived from the resolved identities. Proposed actions wait for an operator; suppressed actions wait for a steward decision.

Eligibility engine
1,339
Eligibility conflict resolved
1,339 proposed
Claims processor
9,112
Orphan claim re-pointed
9,112 executed
Outreach
7,319
Outreach address corrected, Outreach suppressed pending steward
2,993 proposed4,326 held
Next-best-action
3,896
Care coordination outreach, New member onboarding
3,896 proposed
Member services
4,974
Duplicate member record retired
4,974 executed

Actions

26,640 derived from the last resolution run

TypeAllOrphan claim re-pointed9,112
StatusAllProposed8,228Executed14,086Held4,326Released0
ActionTypeTitleDetailLinked toStatusExecuted
ACT-006890
Orphan claim re-pointed
Claims processor
CLM-424833 → UHC-65868-91 (Joe Weaver)
Member id
UHC-65868-91
Confidence
1
Method
probabilistic
MBR-008077CLM-424833
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006891
Orphan claim re-pointed
Claims processor
CLM-406936 → UHC-21773-81 (Hannah Alvarado)
Member id
UHC-21773-81
Confidence
1
Method
probabilistic
MBR-000789CLM-406936
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006892
Orphan claim re-pointed
Claims processor
CLM-414914 → UHC-85538-22 (Karen Reid)
Member id
UHC-85538-22
Confidence
0.93
Method
probabilistic
MBR-012362CLM-414914
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006893
Orphan claim re-pointed
Claims processor
CLM-412366 → UHC-00101-50 (Madison Webb)
Member id
UHC-00101-50
Confidence
0.97
Method
deterministic
MBR-014555CLM-412366
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006894
Orphan claim re-pointed
Claims processor
CLM-414387 → UHC-28618-98 (Carl Vasquez)
Member id
UHC-28618-98
Confidence
0.99
Method
probabilistic
MBR-037230CLM-414387
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006895
Orphan claim re-pointed
Claims processor
CLM-401061 → UHC-71981-48 (Gerald Stephens)
Member id
UHC-71981-48
Confidence
1
Method
probabilistic
MBR-025262CLM-401061
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006896
Orphan claim re-pointed
Claims processor
CLM-408073 → UHC-66449-14 (James Rodriguez)
Member id
UHC-66449-14
Confidence
1
Method
probabilistic
MBR-010720CLM-408073
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006897
Orphan claim re-pointed
Claims processor
CLM-422990 → UHC-16753-86 (Joe Kennedy)
Member id
UHC-16753-86
Confidence
1
Method
probabilistic
MBR-010212CLM-422990
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006898
Orphan claim re-pointed
Claims processor
CLM-421598 → UHC-89226-72 (Jacob Ramirez)
Member id
UHC-89226-72
Confidence
1
Method
probabilistic
MBR-020000CLM-421598
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006899
Orphan claim re-pointed
Claims processor
CLM-428371 → UHC-46632-04 (Beverly Andrews)
Member id
UHC-46632-04
Confidence
1
Method
probabilistic
MBR-036458CLM-428371
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006900
Orphan claim re-pointed
Claims processor
CLM-427154 → UHC-16769-64 (Lauren Hoffman)
Member id
UHC-16769-64
Confidence
1
Method
probabilistic
MBR-027375CLM-427154
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006901
Orphan claim re-pointed
Claims processor
CLM-411147 → UHC-28541-33 (Noah Burns)
Member id
UHC-28541-33
Confidence
1
Method
probabilistic
MBR-009217CLM-411147
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006902
Orphan claim re-pointed
Claims processor
CLM-428769 → UHC-21688-31 (Kyle Delgado)
Member id
UHC-21688-31
Confidence
1
Method
probabilistic
MBR-011157CLM-428769
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006903
Orphan claim re-pointed
Claims processor
CLM-406325 → UHC-84855-86 (Jeremy Ramos)
Member id
UHC-84855-86
Confidence
1
Method
probabilistic
MBR-002722CLM-406325
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006904
Orphan claim re-pointed
Claims processor
CLM-402224 → UHC-70976-57 (Kimberly Morris)
Member id
UHC-70976-57
Confidence
1
Method
probabilistic
MBR-016431CLM-402224
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006905
Orphan claim re-pointed
Claims processor
CLM-419479 → UHC-40288-97 (Albert Park)
Member id
UHC-40288-97
Confidence
1
Method
probabilistic
MBR-017244CLM-419479
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006906
Orphan claim re-pointed
Claims processor
CLM-412656 → UHC-12513-30 (Elizabeth Chapman)
Member id
UHC-12513-30
Confidence
0.94
Method
probabilistic
MBR-032463CLM-412656
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006907
Orphan claim re-pointed
Claims processor
CLM-408261 → UHC-34387-88 (Perry Arthur)
Member id
UHC-34387-88
Confidence
0.99
Method
probabilistic
MBR-042967CLM-408261
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006908
Orphan claim re-pointed
Claims processor
CLM-422583 → UHC-46207-33 (John Hughes)
Member id
UHC-46207-33
Confidence
1
Method
probabilistic
MBR-010389CLM-422583
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006909
Orphan claim re-pointed
Claims processor
CLM-411967 → UHC-35000-43 (Brian Hoffman)
Member id
UHC-35000-43
Confidence
1
Method
probabilistic
MBR-009706CLM-411967
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006910
Orphan claim re-pointed
Claims processor
CLM-422492 → UHC-46520-71 (Christian Peterson)
Member id
UHC-46520-71
Confidence
1
Method
probabilistic
MBR-000204CLM-422492
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006911
Orphan claim re-pointed
Claims processor
CLM-421354 → UHC-41910-36 (Jacqueline Singh)
Member id
UHC-41910-36
Confidence
0.99
Method
probabilistic
MBR-035679CLM-421354
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006912
Orphan claim re-pointed
Claims processor
CLM-429261 → UHC-93074-69 (Nicholas Carr)
Member id
UHC-93074-69
Confidence
1
Method
probabilistic
MBR-018998CLM-429261
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006913
Orphan claim re-pointed
Claims processor
CLM-412188 → UHC-95659-89 (Edward Myers)
Member id
UHC-95659-89
Confidence
1
Method
probabilistic
MBR-008443CLM-412188
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006914
Orphan claim re-pointed
Claims processor
CLM-408939 → UHC-86282-68 (Susan Garrett)
Member id
UHC-86282-68
Confidence
1
Method
probabilistic
MBR-000426CLM-408939
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006915
Orphan claim re-pointed
Claims processor
CLM-403346 → UHC-72868-40 (Sofia Vargas)
Member id
UHC-72868-40
Confidence
1
Method
probabilistic
MBR-006981CLM-403346
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006916
Orphan claim re-pointed
Claims processor
CLM-428871 → UHC-39159-19 (Walter Carlson)
Member id
UHC-39159-19
Confidence
1
Method
probabilistic
MBR-022203CLM-428871
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006917
Orphan claim re-pointed
Claims processor
CLM-412945 → UHC-66079-97 (Kyle Phillips)
Member id
UHC-66079-97
Confidence
0.97
Method
deterministic
MBR-000157CLM-412945
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006918
Orphan claim re-pointed
Claims processor
CLM-406597 → UHC-02077-12 (Hiroshi Lewis)
Member id
UHC-02077-12
Confidence
0.99
Method
probabilistic
MBR-008672CLM-406597
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006919
Orphan claim re-pointed
Claims processor
CLM-408556 → UHC-16873-01 (Samantha Alvarado)
Member id
UHC-16873-01
Confidence
1
Method
probabilistic
MBR-007227CLM-408556
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006920
Orphan claim re-pointed
Claims processor
CLM-403956 → UHC-64051-96 (Eric Myers)
Member id
UHC-64051-96
Confidence
1
Method
probabilistic
MBR-007660CLM-403956
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006921
Orphan claim re-pointed
Claims processor
CLM-413856 → UHC-60806-43 (Gloria Tran)
Member id
UHC-60806-43
Confidence
1
Method
probabilistic
MBR-032845CLM-413856
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006922
Orphan claim re-pointed
Claims processor
CLM-404843 → UHC-27496-70 (Yuki Nguyen)
Member id
UHC-27496-70
Confidence
0.93
Method
probabilistic
MBR-021547CLM-404843
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006923
Orphan claim re-pointed
Claims processor
CLM-427178 → UHC-01681-94 (Steven Vargas)
Member id
UHC-01681-94
Confidence
1
Method
probabilistic
MBR-019111CLM-427178
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006924
Orphan claim re-pointed
Claims processor
CLM-405422 → UHC-15378-08 (Elijah Cox)
Member id
UHC-15378-08
Confidence
1
Method
probabilistic
MBR-021284CLM-405422
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006925
Orphan claim re-pointed
Claims processor
CLM-404739 → UHC-23263-97 (Olivia Clark)
Member id
UHC-23263-97
Confidence
1
Method
probabilistic
MBR-020648CLM-404739
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006926
Orphan claim re-pointed
Claims processor
CLM-424778 → UHC-85423-07 (Frank Chavez)
Member id
UHC-85423-07
Confidence
0.97
Method
deterministic
MBR-017650CLM-424778
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006927
Orphan claim re-pointed
Claims processor
CLM-418476 → UHC-01651-17 (Ana Ward)
Member id
UHC-01651-17
Confidence
1
Method
probabilistic
MBR-030728CLM-418476
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006928
Orphan claim re-pointed
Claims processor
CLM-401163 → UHC-83592-91 (Sara Guzman)
Member id
UHC-83592-91
Confidence
1
Method
probabilistic
MBR-018579CLM-401163
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006929
Orphan claim re-pointed
Claims processor
CLM-432344 → UHC-21632-60 (Jeremy Mendez)
Member id
UHC-21632-60
Confidence
0.99
Method
probabilistic
MBR-037651CLM-432344
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006930
Orphan claim re-pointed
Claims processor
CLM-413748 → UHC-39290-28 (Pamela Gutierrez)
Member id
UHC-39290-28
Confidence
0.97
Method
deterministic
MBR-035206CLM-413748
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006931
Orphan claim re-pointed
Claims processor
CLM-430063 → UHC-86199-06 (Benjamin Taylor)
Member id
UHC-86199-06
Confidence
1.00
Method
probabilistic
MBR-018166CLM-430063
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006932
Orphan claim re-pointed
Claims processor
CLM-432236 → UHC-26182-08 (Aisha Gardner)
Member id
UHC-26182-08
Confidence
1
Method
probabilistic
MBR-002546CLM-432236
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006933
Orphan claim re-pointed
Claims processor
CLM-422525 → UHC-31180-51 (Jonh Lynch)
Member id
UHC-31180-51
Confidence
1
Method
probabilistic
MBR-027327CLM-422525
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006934
Orphan claim re-pointed
Claims processor
CLM-419899 → UHC-83000-99 (Amy Castillo)
Member id
UHC-83000-99
Confidence
1
Method
probabilistic
MBR-009038CLM-419899
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006935
Orphan claim re-pointed
Claims processor
CLM-421732 → UHC-43398-29 (Susan Mason)
Member id
UHC-43398-29
Confidence
1
Method
probabilistic
MBR-015891CLM-421732
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006936
Orphan claim re-pointed
Claims processor
CLM-417580 → UHC-16030-05 (Henry Graham)
Member id
UHC-16030-05
Confidence
1
Method
probabilistic
MBR-003205CLM-417580
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006937
Orphan claim re-pointed
Claims processor
CLM-412194 → UHC-98578-71 (Ralph Rios)
Member id
UHC-98578-71
Confidence
1
Method
probabilistic
MBR-023195CLM-412194
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006938
Orphan claim re-pointed
Claims processor
CLM-420558 → UHC-11551-57 (Ethan Rose)
Member id
UHC-11551-57
Confidence
1
Method
probabilistic
MBR-042096CLM-420558
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006939
Orphan claim re-pointed
Claims processor
CLM-420137 → UHC-10024-45 (Alexander Patterson)
Member id
UHC-10024-45
Confidence
1
Method
probabilistic
MBR-004169CLM-420137
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 112 of 183PreviousNext

Derivation rules

Evaluated after every gold rebuild

  1. 1
    Eligibility conflict resolved
    The records behind one identity disagree on plan code. Survivorship picks the enrollment plan; the eligibility engine is told which one is canonical.
  2. 2
    Orphan claim re-pointed
    A claim arrived without a member ID. Resolution attached it to an identity that has one, so the claims processor can now pay it against the right member.
  3. 3
    Outreach address corrected
    The most recent address on the golden record differs from what enrollment holds. Outreach gets the current address before the next mailing.
  4. 4
    Outreach suppressed pending steward
    The record is sitting in an open steward case. Nothing sensitive is sent until a person decides, so we never message the wrong member.
  5. 5
    Care coordination outreach
    Three or more claims and no provider record. Next-best-action proposes assigning a PCP and scheduling a care-coordination call.
  6. 6
    New member onboarding
    A single, fresh enrollment with no other activity yet. Next-best-action proposes the welcome kit and a digital ID card.
  7. 7
    Duplicate member record retired
    Two or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.