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-007340
Orphan claim re-pointed
Claims processor
CLM-428952 → UHC-11050-43 (Lori Miller)
Member id
UHC-11050-43
Confidence
0.97
Method
deterministic
MBR-015093CLM-428952
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007341
Orphan claim re-pointed
Claims processor
CLM-406129 → UHC-67914-70 (Benjamin Fowler)
Member id
UHC-67914-70
Confidence
0.97
Method
deterministic
MBR-032499CLM-406129
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007342
Orphan claim re-pointed
Claims processor
CLM-414355 → UHC-04909-22 (Rebecca Lewis)
Member id
UHC-04909-22
Confidence
0.97
Method
deterministic
MBR-003560CLM-414355
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007343
Orphan claim re-pointed
Claims processor
CLM-415050 → UHC-69500-16 (Vincent Gutierrez)
Member id
UHC-69500-16
Confidence
1
Method
probabilistic
MBR-035123CLM-415050
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007344
Orphan claim re-pointed
Claims processor
CLM-403326 → UHC-87519-98 (Helen Snyder)
Member id
UHC-87519-98
Confidence
1
Method
probabilistic
MBR-014927CLM-403326
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007345
Orphan claim re-pointed
Claims processor
CLM-432146 → UHC-52291-89 (Donna Lawson)
Member id
UHC-52291-89
Confidence
0.98
Method
probabilistic
MBR-021214CLM-432146
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007346
Orphan claim re-pointed
Claims processor
CLM-402531 → UHC-02095-60 (Carl Robertson)
Member id
UHC-02095-60
Confidence
1
Method
probabilistic
MBR-015526CLM-402531
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007347
Orphan claim re-pointed
Claims processor
CLM-417810 → UHC-98053-18 (Donna Perez)
Member id
UHC-98053-18
Confidence
1
Method
probabilistic
MBR-027137CLM-417810
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007348
Orphan claim re-pointed
Claims processor
CLM-418294 → UHC-60893-02 (Jonathan Hughes)
Member id
UHC-60893-02
Confidence
1
Method
probabilistic
MBR-002507CLM-418294
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007349
Orphan claim re-pointed
Claims processor
CLM-430908 → UHC-68169-21 (Jose Pena)
Member id
UHC-68169-21
Confidence
0.98
Method
probabilistic
MBR-025966CLM-430908
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007350
Orphan claim re-pointed
Claims processor
CLM-410328 → UHC-10708-73 (Brian Roberts)
Member id
UHC-10708-73
Confidence
1
Method
probabilistic
MBR-027269CLM-410328
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007351
Orphan claim re-pointed
Claims processor
CLM-410834 → UHC-51902-38 (Albert Lucas)
Member id
UHC-51902-38
Confidence
1
Method
probabilistic
MBR-015661CLM-410834
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007352
Orphan claim re-pointed
Claims processor
CLM-421641 → UHC-37745-14 (Sarah Richards)
Member id
UHC-37745-14
Confidence
0.94
Method
probabilistic
MBR-023662CLM-421641
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007353
Orphan claim re-pointed
Claims processor
CLM-409200 → UHC-78709-34 (Angela Murphy)
Member id
UHC-78709-34
Confidence
0.88
Method
probabilistic
MBR-001235CLM-409200
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007354
Orphan claim re-pointed
Claims processor
CLM-404301 → UHC-54477-15 (Eugene Delgado)
Member id
UHC-54477-15
Confidence
1
Method
probabilistic
MBR-002255CLM-404301
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007355
Orphan claim re-pointed
Claims processor
CLM-430600 → UHC-08712-31 (Willie Sims)
Member id
UHC-08712-31
Confidence
1
Method
probabilistic
MBR-002738CLM-430600
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007356
Orphan claim re-pointed
Claims processor
CLM-408927 → UHC-23202-90 (Paul Warren)
Member id
UHC-23202-90
Confidence
0.97
Method
deterministic
MBR-027322CLM-408927
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007357
Orphan claim re-pointed
Claims processor
CLM-410087 → UHC-62092-10 (Helen Guzman)
Member id
UHC-62092-10
Confidence
1
Method
probabilistic
MBR-012024CLM-410087
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007358
Orphan claim re-pointed
Claims processor
CLM-414856 → UHC-12549-84 (Donald Gonzales)
Member id
UHC-12549-84
Confidence
1
Method
probabilistic
MBR-000951CLM-414856
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007359
Orphan claim re-pointed
Claims processor
CLM-412901 → UHC-21901-22 (Amy Dominguez)
Member id
UHC-21901-22
Confidence
0.97
Method
deterministic
MBR-014622CLM-412901
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007360
Orphan claim re-pointed
Claims processor
CLM-400655 → UHC-80721-02 (Paul Jimenez)
Member id
UHC-80721-02
Confidence
0.97
Method
deterministic
MBR-037164CLM-400655
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007361
Orphan claim re-pointed
Claims processor
CLM-423068 → UHC-63082-94 (Dennis Phillips)
Member id
UHC-63082-94
Confidence
1
Method
probabilistic
MBR-019932CLM-423068
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007362
Orphan claim re-pointed
Claims processor
CLM-412102 → UHC-91457-63 (Ralph Price)
Member id
UHC-91457-63
Confidence
0.93
Method
probabilistic
MBR-018735CLM-412102
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007363
Orphan claim re-pointed
Claims processor
CLM-409895 → UHC-97886-80 (Christine George)
Member id
UHC-97886-80
Confidence
1
Method
probabilistic
MBR-016651CLM-409895
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007364
Orphan claim re-pointed
Claims processor
CLM-420489 → UHC-38914-38 (Abigail Peters)
Member id
UHC-38914-38
Confidence
1
Method
probabilistic
MBR-019993CLM-420489
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007365
Orphan claim re-pointed
Claims processor
CLM-415876 → UHC-66321-60 (Sharon Davis)
Member id
UHC-66321-60
Confidence
0.99
Method
probabilistic
MBR-013373CLM-415876
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007366
Orphan claim re-pointed
Claims processor
CLM-424689 → UHC-78782-59 (Georeg Wright)
Member id
UHC-78782-59
Confidence
1
Method
probabilistic
MBR-031708CLM-424689
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007367
Orphan claim re-pointed
Claims processor
CLM-405012 → UHC-80359-11 (Eugene Roemro)
Member id
UHC-80359-11
Confidence
0.93
Method
probabilistic
MBR-015667CLM-405012
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007368
Orphan claim re-pointed
Claims processor
CLM-415608 → UHC-63429-28 (Larry Mejia)
Member id
UHC-63429-28
Confidence
0.97
Method
deterministic
MBR-031647CLM-415608
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007369
Orphan claim re-pointed
Claims processor
CLM-411797 → UHC-63264-85 (Samantha Walker)
Member id
UHC-63264-85
Confidence
1
Method
probabilistic
MBR-001714CLM-411797
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007370
Orphan claim re-pointed
Claims processor
CLM-425754 → UHC-92965-83 (Abigail Grant)
Member id
UHC-92965-83
Confidence
1
Method
probabilistic
MBR-013325CLM-425754
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007371
Orphan claim re-pointed
Claims processor
CLM-429897 → UHC-38458-94 (Emma Nichols)
Member id
UHC-38458-94
Confidence
0.97
Method
deterministic
MBR-023909CLM-429897
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007372
Orphan claim re-pointed
Claims processor
CLM-418360 → UHC-62516-28 (Dorothy Vega)
Member id
UHC-62516-28
Confidence
1
Method
probabilistic
MBR-001986CLM-418360
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007373
Orphan claim re-pointed
Claims processor
CLM-420573 → UHC-16910-17 (Carl Rivera)
Member id
UHC-16910-17
Confidence
1
Method
probabilistic
MBR-001724CLM-420573
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007374
Orphan claim re-pointed
Claims processor
CLM-412135 → UHC-43606-52 (Roger Rodriguez)
Member id
UHC-43606-52
Confidence
1
Method
probabilistic
MBR-027038CLM-412135
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007375
Orphan claim re-pointed
Claims processor
CLM-417786 → UHC-49446-32 (Walter Chavez)
Member id
UHC-49446-32
Confidence
1
Method
probabilistic
MBR-000462CLM-417786
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007376
Orphan claim re-pointed
Claims processor
CLM-407787 → UHC-57705-65 (Scott Cooper)
Member id
UHC-57705-65
Confidence
0.99
Method
probabilistic
MBR-005339CLM-407787
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007377
Orphan claim re-pointed
Claims processor
CLM-400265 → UHC-52389-49 (Charlotte Ortiz)
Member id
UHC-52389-49
Confidence
1
Method
probabilistic
MBR-001356CLM-400265
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007378
Orphan claim re-pointed
Claims processor
CLM-400131 → UHC-55726-01 (Paul Russell)
Member id
UHC-55726-01
Confidence
1
Method
probabilistic
MBR-013147CLM-400131
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007379
Orphan claim re-pointed
Claims processor
CLM-423116 → UHC-17723-18 (Samantha Dean)
Member id
UHC-17723-18
Confidence
1
Method
probabilistic
MBR-002281CLM-423116
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007380
Orphan claim re-pointed
Claims processor
CLM-409749 → UHC-84376-98 (Isabella Welch)
Member id
UHC-84376-98
Confidence
1
Method
probabilistic
MBR-001770CLM-409749
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007381
Orphan claim re-pointed
Claims processor
CLM-413414 → UHC-95837-67 (Pamela Tran)
Member id
UHC-95837-67
Confidence
1
Method
probabilistic
MBR-025846CLM-413414
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007382
Orphan claim re-pointed
Claims processor
CLM-406703 → UHC-66427-98 (Laura Murray)
Member id
UHC-66427-98
Confidence
1
Method
probabilistic
MBR-011613CLM-406703
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007383
Orphan claim re-pointed
Claims processor
CLM-414075 → UHC-33882-58 (Christina Larson)
Member id
UHC-33882-58
Confidence
0.97
Method
deterministic
MBR-022606CLM-414075
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007384
Orphan claim re-pointed
Claims processor
CLM-413229 → UHC-12296-96 (Omar Morgan)
Member id
UHC-12296-96
Confidence
1
Method
probabilistic
MBR-018304CLM-413229
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007385
Orphan claim re-pointed
Claims processor
CLM-408486 → UHC-39625-55 (Philip Carlson)
Member id
UHC-39625-55
Confidence
0.97
Method
deterministic
MBR-021012CLM-408486
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007386
Orphan claim re-pointed
Claims processor
CLM-403020 → UHC-13925-39 (Willie Woods)
Member id
UHC-13925-39
Confidence
1
Method
probabilistic
MBR-021928CLM-403020
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007387
Orphan claim re-pointed
Claims processor
CLM-405103 → UHC-56374-38 (Arthur Greene)
Member id
UHC-56374-38
Confidence
1
Method
probabilistic
MBR-023040CLM-405103
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007388
Orphan claim re-pointed
Claims processor
CLM-400770 → UHC-07023-35 (Alex Murphy)
Member id
UHC-07023-35
Confidence
1
Method
probabilistic
MBR-001175CLM-400770
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007389
Orphan claim re-pointed
Claims processor
CLM-425668 → UHC-81998-51 (Angela Gonzalez)
Member id
UHC-81998-51
Confidence
0.97
Method
deterministic
MBR-004356CLM-425668
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 121 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.