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-007090
Orphan claim re-pointed
Claims processor
CLM-408372 → UHC-17896-01 (Anna Coleman)
Member id
UHC-17896-01
Confidence
0.99
Method
probabilistic
MBR-012572CLM-408372
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007091
Orphan claim re-pointed
Claims processor
CLM-414886 → UHC-48337-47 (David Ryan)
Member id
UHC-48337-47
Confidence
1
Method
probabilistic
MBR-020233CLM-414886
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007092
Orphan claim re-pointed
Claims processor
CLM-413761 → UHC-84921-80 (Andrea Wilson)
Member id
UHC-84921-80
Confidence
1
Method
probabilistic
MBR-006423CLM-413761
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007093
Orphan claim re-pointed
Claims processor
CLM-400088 → UHC-61834-78 (Wei Garza)
Member id
UHC-61834-78
Confidence
1
Method
probabilistic
MBR-019651CLM-400088
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007094
Orphan claim re-pointed
Claims processor
CLM-429293 → UHC-35294-47 (Ethan Ruiz)
Member id
UHC-35294-47
Confidence
1
Method
probabilistic
MBR-009820CLM-429293
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007095
Orphan claim re-pointed
Claims processor
CLM-405667 → UHC-41947-43 (Jacqueline Fowler)
Member id
UHC-41947-43
Confidence
1
Method
probabilistic
MBR-037989CLM-405667
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007096
Orphan claim re-pointed
Claims processor
CLM-429225 → UHC-11820-74 (Steven Wheeler)
Member id
UHC-11820-74
Confidence
1
Method
probabilistic
MBR-037825CLM-429225
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007097
Orphan claim re-pointed
Claims processor
CLM-412634 → UHC-56622-34 (Mateo Estrada)
Member id
UHC-56622-34
Confidence
1
Method
probabilistic
MBR-006530CLM-412634
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007098
Orphan claim re-pointed
Claims processor
CLM-425606 → UHC-75343-29 (Lauren Wang)
Member id
UHC-75343-29
Confidence
1
Method
probabilistic
MBR-000146CLM-425606
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007099
Orphan claim re-pointed
Claims processor
CLM-409255 → UHC-15357-52 (Douglas Harris)
Member id
UHC-15357-52
Confidence
0.97
Method
deterministic
MBR-036271CLM-409255
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007100
Orphan claim re-pointed
Claims processor
CLM-402800 → UHC-70158-96 (Timothy Wilson)
Member id
UHC-70158-96
Confidence
1
Method
probabilistic
MBR-026366CLM-402800
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007101
Orphan claim re-pointed
Claims processor
CLM-423088 → UHC-83540-64 (Emily Fox)
Member id
UHC-83540-64
Confidence
0.93
Method
probabilistic
MBR-036884CLM-423088
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007102
Orphan claim re-pointed
Claims processor
CLM-415521 → UHC-33418-96 (Bruce Reynolds)
Member id
UHC-33418-96
Confidence
1
Method
probabilistic
MBR-023552CLM-415521
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007103
Orphan claim re-pointed
Claims processor
CLM-429559 → UHC-66040-77 (Bruce Alexander)
Member id
UHC-66040-77
Confidence
1
Method
probabilistic
MBR-025301CLM-429559
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007104
Orphan claim re-pointed
Claims processor
CLM-421335 → UHC-16004-64 (Maria Spencer)
Member id
UHC-16004-64
Confidence
0.97
Method
deterministic
MBR-004414CLM-421335
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007105
Orphan claim re-pointed
Claims processor
CLM-415775 → UHC-50584-31 (Sara Estrada)
Member id
UHC-50584-31
Confidence
0.99
Method
probabilistic
MBR-003264CLM-415775
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007106
Orphan claim re-pointed
Claims processor
CLM-401317 → UHC-47254-57 (Marilyn Miller)
Member id
UHC-47254-57
Confidence
0.97
Method
deterministic
MBR-001763CLM-401317
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007107
Orphan claim re-pointed
Claims processor
CLM-431657 → UHC-98030-27 (Billy Fisher)
Member id
UHC-98030-27
Confidence
1
Method
probabilistic
MBR-004925CLM-431657
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007108
Orphan claim re-pointed
Claims processor
CLM-400988 → UHC-53067-61 (Gloria Moore)
Member id
UHC-53067-61
Confidence
1
Method
probabilistic
MBR-009800CLM-400988
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007109
Orphan claim re-pointed
Claims processor
CLM-417531 → UHC-30073-49 (Jeffrey Singh)
Member id
UHC-30073-49
Confidence
1
Method
probabilistic
MBR-015868CLM-417531
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007110
Orphan claim re-pointed
Claims processor
CLM-410001 → UHC-04817-13 (Priya McDonald)
Member id
UHC-04817-13
Confidence
1
Method
probabilistic
MBR-007102CLM-410001
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007111
Orphan claim re-pointed
Claims processor
CLM-402212 → UHC-27777-76 (Edward Garrett)
Member id
UHC-27777-76
Confidence
1
Method
probabilistic
MBR-038812CLM-402212
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007112
Orphan claim re-pointed
Claims processor
CLM-402657 → UHC-09595-21 (Kathleen Hanson)
Member id
UHC-09595-21
Confidence
0.93
Method
probabilistic
MBR-000630CLM-402657
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007113
Orphan claim re-pointed
Claims processor
CLM-408174 → UHC-11325-94 (Kenneth Kelly)
Member id
UHC-11325-94
Confidence
1
Method
probabilistic
MBR-004686CLM-408174
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007114
Orphan claim re-pointed
Claims processor
CLM-412147 → UHC-48458-09 (Ronald Lopez)
Member id
UHC-48458-09
Confidence
0.99
Method
probabilistic
MBR-002352CLM-412147
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007115
Orphan claim re-pointed
Claims processor
CLM-432024 → UHC-86823-72 (Randy Parker)
Member id
UHC-86823-72
Confidence
1
Method
probabilistic
MBR-000705CLM-432024
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007116
Orphan claim re-pointed
Claims processor
CLM-405786 → UHC-81514-74 (Amanda Larson)
Member id
UHC-81514-74
Confidence
1
Method
probabilistic
MBR-017552CLM-405786
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007117
Orphan claim re-pointed
Claims processor
CLM-406905 → UHC-99232-21 (Lawrence Rice)
Member id
UHC-99232-21
Confidence
0.97
Method
deterministic
MBR-032922CLM-406905
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007118
Orphan claim re-pointed
Claims processor
CLM-420954 → UHC-43105-62 (Denise White)
Member id
UHC-43105-62
Confidence
1
Method
probabilistic
MBR-006305CLM-420954
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007119
Orphan claim re-pointed
Claims processor
CLM-417007 → UHC-49436-32 (Madison Taylor)
Member id
UHC-49436-32
Confidence
1
Method
probabilistic
MBR-027985CLM-417007
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007120
Orphan claim re-pointed
Claims processor
CLM-417767 → UHC-90635-30 (Justin Johnson)
Member id
UHC-90635-30
Confidence
1
Method
probabilistic
MBR-030461CLM-417767
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007121
Orphan claim re-pointed
Claims processor
CLM-405144 → UHC-68210-89 (Alexis Ramirez)
Member id
UHC-68210-89
Confidence
0.97
Method
deterministic
MBR-001796CLM-405144
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007122
Orphan claim re-pointed
Claims processor
CLM-425702 → UHC-87716-71 (Betty Willis)
Member id
UHC-87716-71
Confidence
1
Method
probabilistic
MBR-015683CLM-425702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007123
Orphan claim re-pointed
Claims processor
CLM-408457 → UHC-56014-62 (Tony Luna)
Member id
UHC-56014-62
Confidence
1
Method
probabilistic
MBR-013071CLM-408457
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007124
Orphan claim re-pointed
Claims processor
CLM-428384 → UHC-44333-96 (Danielle Fox)
Member id
UHC-44333-96
Confidence
1
Method
probabilistic
MBR-006616CLM-428384
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007125
Orphan claim re-pointed
Claims processor
CLM-413629 → UHC-64031-66 (Keith Banks)
Member id
UHC-64031-66
Confidence
1
Method
probabilistic
MBR-029725CLM-413629
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007126
Orphan claim re-pointed
Claims processor
CLM-403850 → UHC-60731-35 (Larry Arnold)
Member id
UHC-60731-35
Confidence
1
Method
probabilistic
MBR-009807CLM-403850
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007127
Orphan claim re-pointed
Claims processor
CLM-425860 → UHC-68692-18 (Donna Reed)
Member id
UHC-68692-18
Confidence
1
Method
probabilistic
MBR-001647CLM-425860
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007128
Orphan claim re-pointed
Claims processor
CLM-403248 → UHC-66774-91 (Kenneth Martinez)
Member id
UHC-66774-91
Confidence
1
Method
probabilistic
MBR-016078CLM-403248
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007129
Orphan claim re-pointed
Claims processor
CLM-428623 → UHC-25585-33 (Martha Washington)
Member id
UHC-25585-33
Confidence
1
Method
probabilistic
MBR-019322CLM-428623
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007130
Orphan claim re-pointed
Claims processor
CLM-413571 → UHC-97811-68 (Jonathan Freeman)
Member id
UHC-97811-68
Confidence
1.00
Method
probabilistic
MBR-022522CLM-413571
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007131
Orphan claim re-pointed
Claims processor
CLM-405396 → UHC-39143-11 (Rebecca Austin)
Member id
UHC-39143-11
Confidence
1
Method
probabilistic
MBR-034784CLM-405396
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007132
Orphan claim re-pointed
Claims processor
CLM-423288 → UHC-25477-10 (Richard Hansen)
Member id
UHC-25477-10
Confidence
1
Method
probabilistic
MBR-011482CLM-423288
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007133
Orphan claim re-pointed
Claims processor
CLM-404837 → UHC-98156-98 (Terry Watson)
Member id
UHC-98156-98
Confidence
1
Method
probabilistic
MBR-022161CLM-404837
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007134
Orphan claim re-pointed
Claims processor
CLM-426837 → UHC-26419-88 (Joe Bishop)
Member id
UHC-26419-88
Confidence
1
Method
probabilistic
MBR-009976CLM-426837
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007135
Orphan claim re-pointed
Claims processor
CLM-411448 → UHC-73234-71 (Jacob Rios)
Member id
UHC-73234-71
Confidence
0.99
Method
probabilistic
MBR-015687CLM-411448
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007136
Orphan claim re-pointed
Claims processor
CLM-400431 → UHC-60033-71 (Bradley Carroll)
Member id
UHC-60033-71
Confidence
0.99
Method
probabilistic
MBR-016939CLM-400431
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007137
Orphan claim re-pointed
Claims processor
CLM-430441 → UHC-60914-75 (Gerald Anderson)
Member id
UHC-60914-75
Confidence
1
Method
probabilistic
MBR-004914CLM-430441
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007138
Orphan claim re-pointed
Claims processor
CLM-407700 → UHC-80137-83 (Roger George)
Member id
UHC-80137-83
Confidence
1
Method
probabilistic
MBR-015051CLM-407700
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007139
Orphan claim re-pointed
Claims processor
CLM-401817 → UHC-66810-53 (Carlos Wood)
Member id
UHC-66810-53
Confidence
0.93
Method
probabilistic
MBR-020446CLM-401817
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 116 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.