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-007190
Orphan claim re-pointed
Claims processor
CLM-407327 → UHC-41549-61 (Ana Burns)
Member id
UHC-41549-61
Confidence
1
Method
probabilistic
MBR-005941CLM-407327
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007191
Orphan claim re-pointed
Claims processor
CLM-423961 → UHC-36576-92 (Aisha Gilbert)
Member id
UHC-36576-92
Confidence
1
Method
probabilistic
MBR-004252CLM-423961
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007192
Orphan claim re-pointed
Claims processor
CLM-432119 → UHC-67652-54 (Mateo Coleman)
Member id
UHC-67652-54
Confidence
1
Method
probabilistic
MBR-041611CLM-432119
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007193
Orphan claim re-pointed
Claims processor
CLM-426852 → UHC-25529-53 (Aaron Scott)
Member id
UHC-25529-53
Confidence
1
Method
probabilistic
MBR-015021CLM-426852
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007194
Orphan claim re-pointed
Claims processor
CLM-413528 → UHC-81231-41 (Valentina Baker)
Member id
UHC-81231-41
Confidence
0.97
Method
deterministic
MBR-010770CLM-413528
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007195
Orphan claim re-pointed
Claims processor
CLM-409398 → UHC-96013-13 (Stephen Fowler)
Member id
UHC-96013-13
Confidence
0.97
Method
deterministic
MBR-007044CLM-409398
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007196
Orphan claim re-pointed
Claims processor
CLM-432194 → UHC-92339-35 (Joe Herrera)
Member id
UHC-92339-35
Confidence
0.93
Method
probabilistic
MBR-021265CLM-432194
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007197
Orphan claim re-pointed
Claims processor
CLM-421579 → UHC-75772-33 (Michael Hanson)
Member id
UHC-75772-33
Confidence
1
Method
probabilistic
MBR-015366CLM-421579
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007198
Orphan claim re-pointed
Claims processor
CLM-414820 → UHC-01868-34 (Austin Wood)
Member id
UHC-01868-34
Confidence
1
Method
probabilistic
MBR-026344CLM-414820
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007199
Orphan claim re-pointed
Claims processor
CLM-425414 → UHC-05438-97 (Sean Perkins)
Member id
UHC-05438-97
Confidence
1
Method
probabilistic
MBR-020347CLM-425414
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007200
Orphan claim re-pointed
Claims processor
CLM-422821 → UHC-00925-87 (Jonathan Johnston)
Member id
UHC-00925-87
Confidence
1
Method
probabilistic
MBR-008673CLM-422821
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007201
Orphan claim re-pointed
Claims processor
CLM-429995 → UHC-56997-24 (Ashley Marquez)
Member id
UHC-56997-24
Confidence
1
Method
probabilistic
MBR-008028CLM-429995
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007202
Orphan claim re-pointed
Claims processor
CLM-409499 → UHC-29658-63 (Russell Larson)
Member id
UHC-29658-63
Confidence
0.97
Method
deterministic
MBR-009666CLM-409499
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007203
Orphan claim re-pointed
Claims processor
CLM-407217 → UHC-67186-14 (Theresa Espinoza)
Member id
UHC-67186-14
Confidence
1
Method
probabilistic
MBR-025250CLM-407217
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007204
Orphan claim re-pointed
Claims processor
CLM-423505 → UHC-06958-08 (Judith Romero)
Member id
UHC-06958-08
Confidence
1
Method
probabilistic
MBR-015363CLM-423505
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007205
Orphan claim re-pointed
Claims processor
CLM-426372 → UHC-10097-24 (Sharon Salazar)
Member id
UHC-10097-24
Confidence
1
Method
probabilistic
MBR-021868CLM-426372
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007206
Orphan claim re-pointed
Claims processor
CLM-424495 → UHC-20697-04 (Carol Peterson)
Member id
UHC-20697-04
Confidence
0.97
Method
deterministic
MBR-004128CLM-424495
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007207
Orphan claim re-pointed
Claims processor
CLM-402016 → UHC-66052-13 (Raymond Hall)
Member id
UHC-66052-13
Confidence
1
Method
probabilistic
MBR-017165CLM-402016
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007208
Orphan claim re-pointed
Claims processor
CLM-402853 → UHC-34396-45 (Martha Sanchez)
Member id
UHC-34396-45
Confidence
1
Method
probabilistic
MBR-027829CLM-402853
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007209
Orphan claim re-pointed
Claims processor
CLM-422101 → UHC-28896-64 (Isabella Kelly)
Member id
UHC-28896-64
Confidence
1
Method
probabilistic
MBR-005009CLM-422101
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007210
Orphan claim re-pointed
Claims processor
CLM-426053 → UHC-07093-42 (Luis Reid)
Member id
UHC-07093-42
Confidence
1
Method
probabilistic
MBR-023166CLM-426053
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007211
Orphan claim re-pointed
Claims processor
CLM-430756 → UHC-14087-46 (Jerry Knight)
Member id
UHC-14087-46
Confidence
0.94
Method
probabilistic
MBR-021090CLM-430756
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007212
Orphan claim re-pointed
Claims processor
CLM-403634 → UHC-90506-25 (Henry Marshall)
Member id
UHC-90506-25
Confidence
1.00
Method
probabilistic
MBR-005802CLM-403634
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007213
Orphan claim re-pointed
Claims processor
CLM-428470 → UHC-21156-85 (Cheryl Ferguson)
Member id
UHC-21156-85
Confidence
0.97
Method
deterministic
MBR-017085CLM-428470
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007214
Orphan claim re-pointed
Claims processor
CLM-415575 → UHC-40367-98 (Samuel Kelley)
Member id
UHC-40367-98
Confidence
1
Method
probabilistic
MBR-024503CLM-415575
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007215
Orphan claim re-pointed
Claims processor
CLM-430812 → UHC-64482-19 (Keith Li)
Member id
UHC-64482-19
Confidence
0.97
Method
deterministic
MBR-036787CLM-430812
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007216
Orphan claim re-pointed
Claims processor
CLM-401544 → UHC-12016-86 (Heahter Kelly)
Member id
UHC-12016-86
Confidence
0.97
Method
deterministic
MBR-007057CLM-401544
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007217
Orphan claim re-pointed
Claims processor
CLM-419378 → UHC-85432-06 (Albert Ellis)
Member id
UHC-85432-06
Confidence
1
Method
probabilistic
MBR-005701CLM-419378
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007218
Orphan claim re-pointed
Claims processor
CLM-408544 → UHC-62640-51 (Jean Tran)
Member id
UHC-62640-51
Confidence
0.97
Method
deterministic
MBR-004087CLM-408544
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007219
Orphan claim re-pointed
Claims processor
CLM-405308 → UHC-78551-20 (Jesse Tucker)
Member id
UHC-78551-20
Confidence
1
Method
probabilistic
MBR-017691CLM-405308
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007220
Orphan claim re-pointed
Claims processor
CLM-405336 → UHC-74665-73 (Henry Mitchell)
Member id
UHC-74665-73
Confidence
1
Method
probabilistic
MBR-019774CLM-405336
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007221
Orphan claim re-pointed
Claims processor
CLM-418829 → UHC-30285-90 (Heather Moarles)
Member id
UHC-30285-90
Confidence
1
Method
probabilistic
MBR-018590CLM-418829
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007222
Orphan claim re-pointed
Claims processor
CLM-428864 → UHC-52773-50 (Teresa Watkins)
Member id
UHC-52773-50
Confidence
0.98
Method
probabilistic
MBR-034164CLM-428864
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007223
Orphan claim re-pointed
Claims processor
CLM-410754 → UHC-44037-64 (Jordan George)
Member id
UHC-44037-64
Confidence
0.97
Method
deterministic
MBR-025043CLM-410754
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007224
Orphan claim re-pointed
Claims processor
CLM-400123 → UHC-27224-84 (Betty Weaver)
Member id
UHC-27224-84
Confidence
0.97
Method
deterministic
MBR-006965CLM-400123
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007225
Orphan claim re-pointed
Claims processor
CLM-410954 → UHC-53705-72 (Noah Roberts)
Member id
UHC-53705-72
Confidence
1
Method
probabilistic
MBR-016768CLM-410954
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007226
Orphan claim re-pointed
Claims processor
CLM-431743 → UHC-36385-95 (Judith Mendez)
Member id
UHC-36385-95
Confidence
0.99
Method
probabilistic
MBR-005606CLM-431743
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007227
Orphan claim re-pointed
Claims processor
CLM-426080 → UHC-13514-35 (Mason Smith)
Member id
UHC-13514-35
Confidence
0.97
Method
deterministic
MBR-007303CLM-426080
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007228
Orphan claim re-pointed
Claims processor
CLM-423074 → UHC-62601-51 (Shirley Obrien)
Member id
UHC-62601-51
Confidence
1
Method
probabilistic
MBR-003413CLM-423074
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007229
Orphan claim re-pointed
Claims processor
CLM-402275 → UHC-96313-13 (Nicole Torres)
Member id
UHC-96313-13
Confidence
1
Method
probabilistic
MBR-011022CLM-402275
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007230
Orphan claim re-pointed
Claims processor
CLM-412757 → UHC-23865-08 (Justin Pena)
Member id
UHC-23865-08
Confidence
1
Method
probabilistic
MBR-012071CLM-412757
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007231
Orphan claim re-pointed
Claims processor
CLM-424104 → UHC-36356-27 (Edward George)
Member id
UHC-36356-27
Confidence
1
Method
probabilistic
MBR-004829CLM-424104
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007232
Orphan claim re-pointed
Claims processor
CLM-409542 → UHC-49632-09 (Mark Knight)
Member id
UHC-49632-09
Confidence
1
Method
probabilistic
MBR-009248CLM-409542
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007233
Orphan claim re-pointed
Claims processor
CLM-409696 → UHC-88199-27 (Carlos Chavez)
Member id
UHC-88199-27
Confidence
0.99
Method
probabilistic
MBR-002793CLM-409696
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007234
Orphan claim re-pointed
Claims processor
CLM-414717 → UHC-58402-80 (Brandon Fernandez)
Member id
UHC-58402-80
Confidence
0.97
Method
deterministic
MBR-000266CLM-414717
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007235
Orphan claim re-pointed
Claims processor
CLM-421731 → UHC-49623-35 (Carlos Obrien)
Member id
UHC-49623-35
Confidence
1
Method
probabilistic
MBR-002801CLM-421731
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007236
Orphan claim re-pointed
Claims processor
CLM-426677 → UHC-94994-59 (Betty Pena)
Member id
UHC-94994-59
Confidence
1
Method
probabilistic
MBR-028124CLM-426677
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007237
Orphan claim re-pointed
Claims processor
CLM-416995 → UHC-92544-37 (William Gonzales)
Member id
UHC-92544-37
Confidence
0.98
Method
probabilistic
MBR-008936CLM-416995
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007238
Orphan claim re-pointed
Claims processor
CLM-403510 → UHC-12229-41 (Danielle Bradley)
Member id
UHC-12229-41
Confidence
1
Method
probabilistic
MBR-003110CLM-403510
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007239
Orphan claim re-pointed
Claims processor
CLM-428022 → UHC-05111-02 (Anthony Guerrero)
Member id
UHC-05111-02
Confidence
1
Method
probabilistic
MBR-015890CLM-428022
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 118 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.