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-007140
Orphan claim re-pointed
Claims processor
CLM-427826 → UHC-34630-48 (Natalie Morgan)
Member id
UHC-34630-48
Confidence
1
Method
probabilistic
MBR-014686CLM-427826
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007141
Orphan claim re-pointed
Claims processor
CLM-404948 → UHC-22461-47 (Nicole Rice)
Member id
UHC-22461-47
Confidence
1
Method
probabilistic
MBR-027225CLM-404948
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007142
Orphan claim re-pointed
Claims processor
CLM-416033 → UHC-60936-79 (Marcus Tucker)
Member id
UHC-60936-79
Confidence
0.97
Method
deterministic
MBR-016840CLM-416033
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007143
Orphan claim re-pointed
Claims processor
CLM-414864 → UHC-21871-27 (Scott Gibson)
Member id
UHC-21871-27
Confidence
0.99
Method
probabilistic
MBR-007489CLM-414864
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007144
Orphan claim re-pointed
Claims processor
CLM-429404 → UHC-79908-24 (Edward Edwards)
Member id
UHC-79908-24
Confidence
1
Method
probabilistic
MBR-025267CLM-429404
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007145
Orphan claim re-pointed
Claims processor
CLM-431415 → UHC-36403-64 (Carolyn Richards)
Member id
UHC-36403-64
Confidence
1
Method
probabilistic
MBR-009251CLM-431415
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007146
Orphan claim re-pointed
Claims processor
CLM-429571 → UHC-15588-86 (Jonathan Bryant)
Member id
UHC-15588-86
Confidence
0.97
Method
deterministic
MBR-027308CLM-429571
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007147
Orphan claim re-pointed
Claims processor
CLM-411861 → UHC-91260-88 (Nathan Olson)
Member id
UHC-91260-88
Confidence
1
Method
probabilistic
MBR-015953CLM-411861
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007148
Orphan claim re-pointed
Claims processor
CLM-422238 → UHC-26322-25 (Joseph Daniels)
Member id
UHC-26322-25
Confidence
0.97
Method
deterministic
MBR-009793CLM-422238
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007149
Orphan claim re-pointed
Claims processor
CLM-409219 → UHC-91184-90 (Vincent Gomez)
Member id
UHC-91184-90
Confidence
1
Method
probabilistic
MBR-025742CLM-409219
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007150
Orphan claim re-pointed
Claims processor
CLM-400467 → UHC-08752-97 (Wayne Carpenter)
Member id
UHC-08752-97
Confidence
1
Method
probabilistic
MBR-019707CLM-400467
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007151
Orphan claim re-pointed
Claims processor
CLM-422759 → UHC-13607-07 (Lucia Washington)
Member id
UHC-13607-07
Confidence
1
Method
probabilistic
MBR-023555CLM-422759
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007152
Orphan claim re-pointed
Claims processor
CLM-414124 → UHC-62683-57 (Deborah Burke)
Member id
UHC-62683-57
Confidence
0.99
Method
probabilistic
MBR-032773CLM-414124
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007153
Orphan claim re-pointed
Claims processor
CLM-418631 → UHC-31856-02 (Anthony Fields)
Member id
UHC-31856-02
Confidence
0.98
Method
probabilistic
MBR-031536CLM-418631
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007154
Orphan claim re-pointed
Claims processor
CLM-400877 → UHC-77734-83 (Justin Gordon)
Member id
UHC-77734-83
Confidence
1
Method
probabilistic
MBR-018708CLM-400877
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007155
Orphan claim re-pointed
Claims processor
CLM-413839 → UHC-21374-40 (Dylan Rivera)
Member id
UHC-21374-40
Confidence
1
Method
probabilistic
MBR-016240CLM-413839
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007156
Orphan claim re-pointed
Claims processor
CLM-406757 → UHC-77796-83 (Eugene Elliott)
Member id
UHC-77796-83
Confidence
1
Method
probabilistic
MBR-019649CLM-406757
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007157
Orphan claim re-pointed
Claims processor
CLM-423264 → UHC-68621-79 (Raymond Snyder)
Member id
UHC-68621-79
Confidence
1
Method
probabilistic
MBR-007154CLM-423264
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007158
Orphan claim re-pointed
Claims processor
CLM-425555 → UHC-98623-51 (Kelly Wallace)
Member id
UHC-98623-51
Confidence
1
Method
probabilistic
MBR-015279CLM-425555
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007159
Orphan claim re-pointed
Claims processor
CLM-425310 → UHC-46569-38 (Arthur Carter)
Member id
UHC-46569-38
Confidence
1
Method
probabilistic
MBR-012911CLM-425310
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007160
Orphan claim re-pointed
Claims processor
CLM-421385 → UHC-60404-50 (Diae Nguyen)
Member id
UHC-60404-50
Confidence
0.98
Method
probabilistic
MBR-004786CLM-421385
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007161
Orphan claim re-pointed
Claims processor
CLM-406490 → UHC-95967-21 (Ralph Nguyen)
Member id
UHC-95967-21
Confidence
1
Method
probabilistic
MBR-013755CLM-406490
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007162
Orphan claim re-pointed
Claims processor
CLM-431314 → UHC-94844-47 (Joshua Guerrero)
Member id
UHC-94844-47
Confidence
1
Method
probabilistic
MBR-004457CLM-431314
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007163
Orphan claim re-pointed
Claims processor
CLM-410922 → UHC-67960-13 (Dylan Pierce)
Member id
UHC-67960-13
Confidence
1
Method
probabilistic
MBR-038060CLM-410922
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007164
Orphan claim re-pointed
Claims processor
CLM-416398 → UHC-37033-56 (Logan Wang)
Member id
UHC-37033-56
Confidence
1
Method
probabilistic
MBR-032389CLM-416398
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007165
Orphan claim re-pointed
Claims processor
CLM-424661 → UHC-50017-20 (Henry Jackson)
Member id
UHC-50017-20
Confidence
0.93
Method
probabilistic
MBR-021242CLM-424661
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007166
Orphan claim re-pointed
Claims processor
CLM-426737 → UHC-09236-74 (Juan Carroll)
Member id
UHC-09236-74
Confidence
0.97
Method
deterministic
MBR-022119CLM-426737
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007167
Orphan claim re-pointed
Claims processor
CLM-417057 → UHC-92848-17 (Lauren Simpson)
Member id
UHC-92848-17
Confidence
1
Method
probabilistic
MBR-006093CLM-417057
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007168
Orphan claim re-pointed
Claims processor
CLM-420580 → UHC-97273-56 (Sandra Long)
Member id
UHC-97273-56
Confidence
0.87
Method
probabilistic
MBR-030165CLM-420580
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007169
Orphan claim re-pointed
Claims processor
CLM-404845 → UHC-47377-58 (Joseph Stevens)
Member id
UHC-47377-58
Confidence
1
Method
probabilistic
MBR-019921CLM-404845
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007170
Orphan claim re-pointed
Claims processor
CLM-417579 → UHC-16030-05 (Henry Graham)
Member id
UHC-16030-05
Confidence
1
Method
probabilistic
MBR-003205CLM-417579
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007171
Orphan claim re-pointed
Claims processor
CLM-420293 → UHC-33964-60 (Christian Lopez)
Member id
UHC-33964-60
Confidence
0.97
Method
deterministic
MBR-016854CLM-420293
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007172
Orphan claim re-pointed
Claims processor
CLM-406724 → UHC-04666-05 (Kenneth Hunter)
Member id
UHC-04666-05
Confidence
1
Method
probabilistic
MBR-014019CLM-406724
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007173
Orphan claim re-pointed
Claims processor
CLM-428802 → UHC-96293-11 (Edward Simpson)
Member id
UHC-96293-11
Confidence
1
Method
probabilistic
MBR-005586CLM-428802
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007174
Orphan claim re-pointed
Claims processor
CLM-418939 → UHC-28850-11 (Helen Johnson)
Member id
UHC-28850-11
Confidence
1
Method
probabilistic
MBR-008140CLM-418939
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007175
Orphan claim re-pointed
Claims processor
CLM-425230 → UHC-02912-63 (Bradley Cole)
Member id
UHC-02912-63
Confidence
0.97
Method
deterministic
MBR-030052CLM-425230
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007176
Orphan claim re-pointed
Claims processor
CLM-420711 → UHC-90571-84 (Kathleen Castillo)
Member id
UHC-90571-84
Confidence
0.97
Method
deterministic
MBR-015556CLM-420711
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007177
Orphan claim re-pointed
Claims processor
CLM-402397 → UHC-29381-35 (Hannah Ryan)
Member id
UHC-29381-35
Confidence
0.97
Method
deterministic
MBR-031343CLM-402397
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007178
Orphan claim re-pointed
Claims processor
CLM-423015 → UHC-11528-25 (Isabella Watson)
Member id
UHC-11528-25
Confidence
1
Method
probabilistic
MBR-005561CLM-423015
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007179
Orphan claim re-pointed
Claims processor
CLM-414529 → UHC-91573-67 (Bryan Anderson)
Member id
UHC-91573-67
Confidence
0.97
Method
deterministic
MBR-019573CLM-414529
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007180
Orphan claim re-pointed
Claims processor
CLM-423437 → UHC-21091-76 (Stephen Weber)
Member id
UHC-21091-76
Confidence
1
Method
probabilistic
MBR-018455CLM-423437
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007181
Orphan claim re-pointed
Claims processor
CLM-426874 → UHC-95535-50 (Henry Watson)
Member id
UHC-95535-50
Confidence
1
Method
probabilistic
MBR-006448CLM-426874
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007182
Orphan claim re-pointed
Claims processor
CLM-411106 → UHC-89861-37 (Nancy Evans)
Member id
UHC-89861-37
Confidence
1
Method
probabilistic
MBR-001210CLM-411106
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007183
Orphan claim re-pointed
Claims processor
CLM-407951 → UHC-27499-03 (Rachel Rose)
Member id
UHC-27499-03
Confidence
0.85
Method
probabilistic
MBR-003937CLM-407951
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007184
Orphan claim re-pointed
Claims processor
CLM-404429 → UHC-17367-62 (John Morris)
Member id
UHC-17367-62
Confidence
1
Method
probabilistic
MBR-017226CLM-404429
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007185
Orphan claim re-pointed
Claims processor
CLM-404199 → UHC-10156-16 (Debra Lawson)
Member id
UHC-10156-16
Confidence
0.97
Method
deterministic
MBR-003558CLM-404199
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007186
Orphan claim re-pointed
Claims processor
CLM-413134 → UHC-10198-70 (Marilyn Aguilar)
Member id
UHC-10198-70
Confidence
1
Method
probabilistic
MBR-008183CLM-413134
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007187
Orphan claim re-pointed
Claims processor
CLM-411822 → UHC-15101-05 (Vincent Jones)
Member id
UHC-15101-05
Confidence
1
Method
probabilistic
MBR-008664CLM-411822
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007188
Orphan claim re-pointed
Claims processor
CLM-417410 → UHC-74389-69 (Robert Soto)
Member id
UHC-74389-69
Confidence
0.97
Method
deterministic
MBR-045103CLM-417410
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007189
Orphan claim re-pointed
Claims processor
CLM-425680 → UHC-89493-86 (Janet Mejia)
Member id
UHC-89493-86
Confidence
1
Method
probabilistic
MBR-022653CLM-425680
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 117 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.