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-001890
Orphan claim re-pointed
Claims processor
CLM-415513 → UHC-73080-77 (Olivia Parker)
Member id
UHC-73080-77
Confidence
1
Method
probabilistic
MBR-037192CLM-415513
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001891
Orphan claim re-pointed
Claims processor
CLM-421338 → UHC-14676-12 (Stephanie Alvarado)
Member id
UHC-14676-12
Confidence
0.97
Method
deterministic
MBR-015319CLM-421338
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001892
Orphan claim re-pointed
Claims processor
CLM-401387 → UHC-49702-48 (Katherine Grant)
Member id
UHC-49702-48
Confidence
1
Method
probabilistic
MBR-028115CLM-401387
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001893
Orphan claim re-pointed
Claims processor
CLM-429719 → UHC-53488-77 (Daniel Martinez)
Member id
UHC-53488-77
Confidence
1
Method
probabilistic
MBR-012285CLM-429719
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001894
Orphan claim re-pointed
Claims processor
CLM-422233 → UHC-92658-26 (Patrick Phillips)
Member id
UHC-92658-26
Confidence
0.97
Method
deterministic
MBR-022945CLM-422233
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001895
Orphan claim re-pointed
Claims processor
CLM-422165 → UHC-88822-54 (Billy Collins)
Member id
UHC-88822-54
Confidence
0.97
Method
deterministic
MBR-000038CLM-422165
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001896
Orphan claim re-pointed
Claims processor
CLM-417700 → UHC-89314-56 (Noah Rogers)
Member id
UHC-89314-56
Confidence
1
Method
probabilistic
MBR-005517CLM-417700
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001897
Orphan claim re-pointed
Claims processor
CLM-430415 → UHC-71193-02 (Valentina Guerrero)
Member id
UHC-71193-02
Confidence
1
Method
probabilistic
MBR-028670CLM-430415
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001898
Orphan claim re-pointed
Claims processor
CLM-428741 → UHC-07918-81 (Henry Roberts)
Member id
UHC-07918-81
Confidence
0.97
Method
deterministic
MBR-031811CLM-428741
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001899
Orphan claim re-pointed
Claims processor
CLM-432554 → UHC-00116-94 (Sandra Scott)
Member id
UHC-00116-94
Confidence
0.99
Method
probabilistic
MBR-001678CLM-432554
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001900
Orphan claim re-pointed
Claims processor
CLM-406454 → UHC-02912-01 (Grace Mdeina)
Member id
UHC-02912-01
Confidence
0.99
Method
probabilistic
MBR-004597CLM-406454
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001901
Orphan claim re-pointed
Claims processor
CLM-400232 → UHC-55219-48 (Austin Stone)
Member id
UHC-55219-48
Confidence
0.97
Method
deterministic
MBR-019088CLM-400232
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001902
Orphan claim re-pointed
Claims processor
CLM-401634 → UHC-05553-13 (Austin Torres)
Member id
UHC-05553-13
Confidence
1
Method
probabilistic
MBR-009760CLM-401634
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001903
Orphan claim re-pointed
Claims processor
CLM-418777 → UHC-29945-79 (Richard Hicks)
Member id
UHC-29945-79
Confidence
1
Method
probabilistic
MBR-027790CLM-418777
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001904
Orphan claim re-pointed
Claims processor
CLM-417684 → UHC-62167-58 (Amy Evans)
Member id
UHC-62167-58
Confidence
1
Method
probabilistic
MBR-023277CLM-417684
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001905
Orphan claim re-pointed
Claims processor
CLM-417688 → UHC-47120-09 (Patricia Cooper)
Member id
UHC-47120-09
Confidence
0.97
Method
deterministic
MBR-029092CLM-417688
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001906
Orphan claim re-pointed
Claims processor
CLM-422957 → UHC-76265-13 (Kathleen Fisher)
Member id
UHC-76265-13
Confidence
1
Method
probabilistic
MBR-037361CLM-422957
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001907
Orphan claim re-pointed
Claims processor
CLM-424175 → UHC-90955-10 (Doris Rice)
Member id
UHC-90955-10
Confidence
1
Method
probabilistic
MBR-036564CLM-424175
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001908
Orphan claim re-pointed
Claims processor
CLM-407859 → UHC-88715-46 (Ronald Espinoza)
Member id
UHC-88715-46
Confidence
1
Method
probabilistic
MBR-002670CLM-407859
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001909
Orphan claim re-pointed
Claims processor
CLM-427629 → UHC-52328-19 (Jordan Banks)
Member id
UHC-52328-19
Confidence
1
Method
probabilistic
MBR-010991CLM-427629
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001910
Orphan claim re-pointed
Claims processor
CLM-403878 → UHC-38340-41 (Andrea Brown)
Member id
UHC-38340-41
Confidence
1
Method
probabilistic
MBR-007086CLM-403878
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001911
Orphan claim re-pointed
Claims processor
CLM-402340 → UHC-46654-44 (Aisha Simmons)
Member id
UHC-46654-44
Confidence
1
Method
probabilistic
MBR-006954CLM-402340
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001912
Orphan claim re-pointed
Claims processor
CLM-428387 → UHC-28056-92 (Harold Montgomery)
Member id
UHC-28056-92
Confidence
1
Method
probabilistic
MBR-022689CLM-428387
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001913
Orphan claim re-pointed
Claims processor
CLM-409886 → UHC-22343-80 (Bobby Ferguson)
Member id
UHC-22343-80
Confidence
1
Method
probabilistic
MBR-000343CLM-409886
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001914
Orphan claim re-pointed
Claims processor
CLM-407098 → UHC-37501-46 (Gerald Wagner)
Member id
UHC-37501-46
Confidence
1
Method
probabilistic
MBR-004344CLM-407098
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001915
Orphan claim re-pointed
Claims processor
CLM-410671 → UHC-95603-42 (Michael Lopez)
Member id
UHC-95603-42
Confidence
1
Method
probabilistic
MBR-021313CLM-410671
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001916
Orphan claim re-pointed
Claims processor
CLM-402125 → UHC-51969-60 (Isabella Dominguez)
Member id
UHC-51969-60
Confidence
0.99
Method
probabilistic
MBR-021374CLM-402125
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001917
Orphan claim re-pointed
Claims processor
CLM-432660 → UHC-62359-22 (Brian Hughes)
Member id
UHC-62359-22
Confidence
0.97
Method
deterministic
MBR-007386CLM-432660
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001918
Orphan claim re-pointed
Claims processor
CLM-422924 → UHC-25565-57 (Ahmed Murray)
Member id
UHC-25565-57
Confidence
0.99
Method
probabilistic
MBR-022662CLM-422924
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001919
Orphan claim re-pointed
Claims processor
CLM-427643 → UHC-20327-47 (Gary Ross)
Member id
UHC-20327-47
Confidence
0.97
Method
probabilistic
MBR-013148CLM-427643
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001920
Orphan claim re-pointed
Claims processor
CLM-403237 → UHC-69234-20 (Richard Luna)
Member id
UHC-69234-20
Confidence
1
Method
probabilistic
MBR-006585CLM-403237
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001921
Orphan claim re-pointed
Claims processor
CLM-421344 → UHC-96379-79 (Camila Jackson)
Member id
UHC-96379-79
Confidence
0.99
Method
probabilistic
MBR-012406CLM-421344
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001922
Orphan claim re-pointed
Claims processor
CLM-401273 → UHC-76399-31 (Mason Porter)
Member id
UHC-76399-31
Confidence
1
Method
probabilistic
MBR-001447CLM-401273
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001923
Orphan claim re-pointed
Claims processor
CLM-419874 → UHC-65268-22 (Jessiac Reid)
Member id
UHC-65268-22
Confidence
0.97
Method
deterministic
MBR-018189CLM-419874
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001924
Orphan claim re-pointed
Claims processor
CLM-401329 → UHC-13328-28 (Amy Hayes)
Member id
UHC-13328-28
Confidence
1
Method
probabilistic
MBR-023572CLM-401329
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001925
Orphan claim re-pointed
Claims processor
CLM-409582 → UHC-53110-32 (Jennifer Riley)
Member id
UHC-53110-32
Confidence
1
Method
probabilistic
MBR-011198CLM-409582
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001926
Orphan claim re-pointed
Claims processor
CLM-424345 → UHC-60010-83 (Heather Vazquez)
Member id
UHC-60010-83
Confidence
0.97
Method
deterministic
MBR-010791CLM-424345
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001927
Orphan claim re-pointed
Claims processor
CLM-420710 → UHC-90571-84 (Kathleen Castillo)
Member id
UHC-90571-84
Confidence
1
Method
probabilistic
MBR-015556CLM-420710
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001928
Orphan claim re-pointed
Claims processor
CLM-417420 → UHC-72089-26 (Juan Chen)
Member id
UHC-72089-26
Confidence
1
Method
probabilistic
MBR-000735CLM-417420
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001929
Orphan claim re-pointed
Claims processor
CLM-425896 → UHC-84096-55 (Susan Perry)
Member id
UHC-84096-55
Confidence
1
Method
probabilistic
MBR-002349CLM-425896
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001930
Orphan claim re-pointed
Claims processor
CLM-408089 → UHC-90777-05 (Kathryn Perry)
Member id
UHC-90777-05
Confidence
1
Method
probabilistic
MBR-005723CLM-408089
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001931
Orphan claim re-pointed
Claims processor
CLM-401765 → UHC-97777-83 (Walter Wang)
Member id
UHC-97777-83
Confidence
1
Method
probabilistic
MBR-028383CLM-401765
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001932
Orphan claim re-pointed
Claims processor
CLM-420604 → UHC-81240-57 (Billy Wong)
Member id
UHC-81240-57
Confidence
1
Method
probabilistic
MBR-007089CLM-420604
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001933
Orphan claim re-pointed
Claims processor
CLM-404703 → UHC-03406-45 (Joseph Obrien)
Member id
UHC-03406-45
Confidence
1
Method
probabilistic
MBR-023190CLM-404703
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001934
Orphan claim re-pointed
Claims processor
CLM-423577 → UHC-11079-43 (Peter Hernandez)
Member id
UHC-11079-43
Confidence
1
Method
probabilistic
MBR-023901CLM-423577
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001935
Orphan claim re-pointed
Claims processor
CLM-427855 → UHC-45242-14 (Sara Hawkins)
Member id
UHC-45242-14
Confidence
0.97
Method
deterministic
MBR-031195CLM-427855
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001936
Orphan claim re-pointed
Claims processor
CLM-426194 → UHC-65976-64 (Judy Day)
Member id
UHC-65976-64
Confidence
1
Method
probabilistic
MBR-001433CLM-426194
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001937
Orphan claim re-pointed
Claims processor
CLM-425142 → UHC-18562-31 (Gerald Watson)
Member id
UHC-18562-31
Confidence
0.93
Method
probabilistic
MBR-012383CLM-425142
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001938
Orphan claim re-pointed
Claims processor
CLM-416640 → UHC-43941-81 (Ralph Ruiz)
Member id
UHC-43941-81
Confidence
1
Method
probabilistic
MBR-017033CLM-416640
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001939
Orphan claim re-pointed
Claims processor
CLM-428903 → UHC-01255-44 (William Carpenter)
Member id
UHC-01255-44
Confidence
1
Method
probabilistic
MBR-031905CLM-428903
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 12 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.