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-007290
Orphan claim re-pointed
Claims processor
CLM-404794 → UHC-96131-84 (Patrick Spencer)
Member id
UHC-96131-84
Confidence
1
Method
probabilistic
MBR-032086CLM-404794
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007291
Orphan claim re-pointed
Claims processor
CLM-421822 → UHC-11214-95 (Jeffrey Martin)
Member id
UHC-11214-95
Confidence
0.97
Method
deterministic
MBR-002346CLM-421822
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007292
Orphan claim re-pointed
Claims processor
CLM-432373 → UHC-12963-51 (Debra Aguilar)
Member id
UHC-12963-51
Confidence
1
Method
probabilistic
MBR-012389CLM-432373
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007293
Orphan claim re-pointed
Claims processor
CLM-428198 → UHC-05897-89 (Jesse Baker)
Member id
UHC-05897-89
Confidence
1
Method
probabilistic
MBR-019989CLM-428198
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007294
Orphan claim re-pointed
Claims processor
CLM-404025 → UHC-59897-08 (Katherine Dean)
Member id
UHC-59897-08
Confidence
0.87
Method
probabilistic
MBR-035595CLM-404025
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007295
Orphan claim re-pointed
Claims processor
CLM-404532 → UHC-53774-63 (Hiroshi Kelley)
Member id
UHC-53774-63
Confidence
0.97
Method
deterministic
MBR-022485CLM-404532
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007296
Orphan claim re-pointed
Claims processor
CLM-422834 → UHC-10956-01 (Jacqueline Willis)
Member id
UHC-10956-01
Confidence
0.97
Method
deterministic
MBR-025121CLM-422834
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007297
Orphan claim re-pointed
Claims processor
CLM-418456 → UHC-38729-59 (Gabriel Cole)
Member id
UHC-38729-59
Confidence
1
Method
probabilistic
MBR-031065CLM-418456
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007298
Orphan claim re-pointed
Claims processor
CLM-432451 → UHC-89494-51 (Catherine Harris)
Member id
UHC-89494-51
Confidence
1
Method
probabilistic
MBR-007632CLM-432451
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007299
Orphan claim re-pointed
Claims processor
CLM-415421 → UHC-81737-68 (Brittany Long)
Member id
UHC-81737-68
Confidence
1
Method
probabilistic
MBR-008540CLM-415421
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007300
Orphan claim re-pointed
Claims processor
CLM-427611 → UHC-30630-78 (Margaret Ryan)
Member id
UHC-30630-78
Confidence
1
Method
probabilistic
MBR-016286CLM-427611
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007301
Orphan claim re-pointed
Claims processor
CLM-423269 → UHC-22787-33 (Brittany Sandoval)
Member id
UHC-22787-33
Confidence
1
Method
probabilistic
MBR-028436CLM-423269
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007302
Orphan claim re-pointed
Claims processor
CLM-430558 → UHC-79512-66 (Valentina Johnston)
Member id
UHC-79512-66
Confidence
0.97
Method
deterministic
MBR-029935CLM-430558
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007303
Orphan claim re-pointed
Claims processor
CLM-429716 → UHC-22561-29 (Laura Torres)
Member id
UHC-22561-29
Confidence
0.97
Method
deterministic
MBR-015010CLM-429716
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007304
Orphan claim re-pointed
Claims processor
CLM-410501 → UHC-66139-13 (Christian Gibson)
Member id
UHC-66139-13
Confidence
1
Method
probabilistic
MBR-023919CLM-410501
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007305
Orphan claim re-pointed
Claims processor
CLM-414217 → UHC-83009-59 (Helen Graham)
Member id
UHC-83009-59
Confidence
1
Method
probabilistic
MBR-012014CLM-414217
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007306
Orphan claim re-pointed
Claims processor
CLM-404336 → UHC-10602-08 (Kyle Guzman)
Member id
UHC-10602-08
Confidence
0.97
Method
deterministic
MBR-027264CLM-404336
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007307
Orphan claim re-pointed
Claims processor
CLM-424021 → UHC-58273-21 (Mike Contreras)
Member id
UHC-58273-21
Confidence
1
Method
probabilistic
MBR-036619CLM-424021
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007308
Orphan claim re-pointed
Claims processor
CLM-430559 → UHC-79512-66 (Valentina Johnston)
Member id
UHC-79512-66
Confidence
0.93
Method
probabilistic
MBR-029935CLM-430559
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007309
Orphan claim re-pointed
Claims processor
CLM-420650 → UHC-96665-83 (Megan Clark)
Member id
UHC-96665-83
Confidence
0.94
Method
probabilistic
MBR-003947CLM-420650
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007310
Orphan claim re-pointed
Claims processor
CLM-408155 → UHC-15522-20 (Elijah Allen)
Member id
UHC-15522-20
Confidence
1
Method
probabilistic
MBR-018217CLM-408155
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007311
Orphan claim re-pointed
Claims processor
CLM-415046 → UHC-74879-57 (Nataliie Cox)
Member id
UHC-74879-57
Confidence
0.97
Method
deterministic
MBR-013207CLM-415046
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007312
Orphan claim re-pointed
Claims processor
CLM-414440 → UHC-64017-72 (Evelyn Guzman)
Member id
UHC-64017-72
Confidence
1
Method
probabilistic
MBR-005772CLM-414440
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007313
Orphan claim re-pointed
Claims processor
CLM-414294 → UHC-05912-11 (Camila Ortiz)
Member id
UHC-05912-11
Confidence
0.93
Method
probabilistic
MBR-038267CLM-414294
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007314
Orphan claim re-pointed
Claims processor
CLM-415361 → UHC-47531-91 (Ruth West)
Member id
UHC-47531-91
Confidence
1
Method
probabilistic
MBR-016213CLM-415361
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007315
Orphan claim re-pointed
Claims processor
CLM-404926 → UHC-37349-81 (Jon McCoy)
Member id
UHC-37349-81
Confidence
0.97
Method
deterministic
MBR-028199CLM-404926
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007316
Orphan claim re-pointed
Claims processor
CLM-404017 → UHC-95780-81 (Betty Olson)
Member id
UHC-95780-81
Confidence
1
Method
probabilistic
MBR-002457CLM-404017
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007317
Orphan claim re-pointed
Claims processor
CLM-407170 → UHC-65344-16 (Nicholas Gibson)
Member id
UHC-65344-16
Confidence
1
Method
probabilistic
MBR-009391CLM-407170
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007318
Orphan claim re-pointed
Claims processor
CLM-428772 → UHC-13234-84 (Arthur Martinnez)
Member id
UHC-13234-84
Confidence
0.97
Method
deterministic
MBR-026023CLM-428772
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007319
Orphan claim re-pointed
Claims processor
CLM-423551 → UHC-97296-45 (Doris Castillo)
Member id
UHC-97296-45
Confidence
0.93
Method
probabilistic
MBR-003056CLM-423551
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007320
Orphan claim re-pointed
Claims processor
CLM-431128 → UHC-22904-19 (Sarah Hamilton)
Member id
UHC-22904-19
Confidence
0.99
Method
probabilistic
MBR-018911CLM-431128
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007321
Orphan claim re-pointed
Claims processor
CLM-427132 → UHC-42284-52 (Nathan Lawrence)
Member id
UHC-42284-52
Confidence
0.99
Method
probabilistic
MBR-001517CLM-427132
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007322
Orphan claim re-pointed
Claims processor
CLM-405030 → UHC-92637-64 (Christopher Cunningham)
Member id
UHC-92637-64
Confidence
1
Method
probabilistic
MBR-003293CLM-405030
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007323
Orphan claim re-pointed
Claims processor
CLM-428672 → UHC-07231-79 (Jordan Wood)
Member id
UHC-07231-79
Confidence
0.93
Method
probabilistic
MBR-032539CLM-428672
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007324
Orphan claim re-pointed
Claims processor
CLM-428602 → UHC-94886-33 (Aisha Rojas)
Member id
UHC-94886-33
Confidence
1
Method
probabilistic
MBR-021466CLM-428602
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007325
Orphan claim re-pointed
Claims processor
CLM-431396 → UHC-17996-45 (Michelle Bryant)
Member id
UHC-17996-45
Confidence
1
Method
probabilistic
MBR-032653CLM-431396
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007326
Orphan claim re-pointed
Claims processor
CLM-412756 → UHC-89231-52 (Wayne Bell)
Member id
UHC-89231-52
Confidence
1
Method
probabilistic
MBR-008863CLM-412756
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007327
Orphan claim re-pointed
Claims processor
CLM-404310 → UHC-16993-83 (Jacqueline Jimenez)
Member id
UHC-16993-83
Confidence
1
Method
probabilistic
MBR-002393CLM-404310
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007328
Orphan claim re-pointed
Claims processor
CLM-423733 → UHC-27605-62 (Luis Alexander)
Member id
UHC-27605-62
Confidence
1
Method
probabilistic
MBR-014900CLM-423733
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007329
Orphan claim re-pointed
Claims processor
CLM-409301 → UHC-53249-64 (Nataliie Wells)
Member id
UHC-53249-64
Confidence
0.97
Method
deterministic
MBR-002958CLM-409301
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007330
Orphan claim re-pointed
Claims processor
CLM-427665 → UHC-65598-14 (Alexis Bennett)
Member id
UHC-65598-14
Confidence
1
Method
probabilistic
MBR-003604CLM-427665
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007331
Orphan claim re-pointed
Claims processor
CLM-419043 → UHC-62284-61 (Karen Rivera)
Member id
UHC-62284-61
Confidence
1
Method
probabilistic
MBR-001615CLM-419043
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007332
Orphan claim re-pointed
Claims processor
CLM-414327 → UHC-17982-74 (Theresa Mills)
Member id
UHC-17982-74
Confidence
1
Method
probabilistic
MBR-008277CLM-414327
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007333
Orphan claim re-pointed
Claims processor
CLM-432060 → UHC-26627-21 (Mariana Herrera)
Member id
UHC-26627-21
Confidence
0.97
Method
deterministic
MBR-020230CLM-432060
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007334
Orphan claim re-pointed
Claims processor
CLM-421932 → UHC-83588-76 (Maria Wells)
Member id
UHC-83588-76
Confidence
1
Method
probabilistic
MBR-012710CLM-421932
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007335
Orphan claim re-pointed
Claims processor
CLM-414178 → UHC-92165-97 (Elizabeth Howard)
Member id
UHC-92165-97
Confidence
1
Method
probabilistic
MBR-019829CLM-414178
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007336
Orphan claim re-pointed
Claims processor
CLM-414035 → UHC-13671-78 (Christine Bryant)
Member id
UHC-13671-78
Confidence
1
Method
probabilistic
MBR-000914CLM-414035
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007337
Orphan claim re-pointed
Claims processor
CLM-413019 → UHC-70320-01 (Juan Guerrero)
Member id
UHC-70320-01
Confidence
0.99
Method
probabilistic
MBR-009187CLM-413019
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007338
Orphan claim re-pointed
Claims processor
CLM-401857 → UHC-50709-05 (Samuel Myers)
Member id
UHC-50709-05
Confidence
1
Method
probabilistic
MBR-007214CLM-401857
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007339
Orphan claim re-pointed
Claims processor
CLM-423883 → UHC-20161-23 (Diana Porter)
Member id
UHC-20161-23
Confidence
1
Method
probabilistic
MBR-024329CLM-423883
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 120 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.