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-008090
Orphan claim re-pointed
Claims processor
CLM-431472 → UHC-12167-44 (Carolyn Jordan)
Member id
UHC-12167-44
Confidence
0.97
Method
deterministic
MBR-037700CLM-431472
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008091
Orphan claim re-pointed
Claims processor
CLM-401820 → UHC-64480-79 (Jonathan Rivera)
Member id
UHC-64480-79
Confidence
1
Method
probabilistic
MBR-002406CLM-401820
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008092
Orphan claim re-pointed
Claims processor
CLM-423731 → UHC-61347-45 (Teresa Burton)
Member id
UHC-61347-45
Confidence
1
Method
probabilistic
MBR-024048CLM-423731
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008093
Orphan claim re-pointed
Claims processor
CLM-432173 → UHC-52800-45 (Alice Hart)
Member id
UHC-52800-45
Confidence
1
Method
probabilistic
MBR-041383CLM-432173
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008094
Orphan claim re-pointed
Claims processor
CLM-419127 → UHC-70586-14 (Ethan Wood)
Member id
UHC-70586-14
Confidence
0.99
Method
probabilistic
MBR-040320CLM-419127
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008095
Orphan claim re-pointed
Claims processor
CLM-409528 → UHC-50046-10 (Matthew Hanson)
Member id
UHC-50046-10
Confidence
1
Method
probabilistic
MBR-007945CLM-409528
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008096
Orphan claim re-pointed
Claims processor
CLM-404515 → UHC-29058-69 (Deborah Munoz)
Member id
UHC-29058-69
Confidence
1
Method
probabilistic
MBR-033412CLM-404515
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008097
Orphan claim re-pointed
Claims processor
CLM-413643 → UHC-71517-82 (Lauren Hill)
Member id
UHC-71517-82
Confidence
1
Method
probabilistic
MBR-006426CLM-413643
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008098
Orphan claim re-pointed
Claims processor
CLM-418228 → UHC-34231-80 (Omar Rivera)
Member id
UHC-34231-80
Confidence
0.86
Method
probabilistic
MBR-042743CLM-418228
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008099
Orphan claim re-pointed
Claims processor
CLM-400324 → UHC-47701-51 (Edward Howell)
Member id
UHC-47701-51
Confidence
0.97
Method
deterministic
MBR-010029CLM-400324
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008100
Orphan claim re-pointed
Claims processor
CLM-408976 → UHC-27676-63 (Nicole Sullivan)
Member id
UHC-27676-63
Confidence
0.97
Method
deterministic
MBR-029876CLM-408976
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008101
Orphan claim re-pointed
Claims processor
CLM-428496 → UHC-27495-29 (Priya Shaw)
Member id
UHC-27495-29
Confidence
1
Method
probabilistic
MBR-011434CLM-428496
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008102
Orphan claim re-pointed
Claims processor
CLM-423029 → UHC-34532-34 (Ruth Parker)
Member id
UHC-34532-34
Confidence
1
Method
probabilistic
MBR-030650CLM-423029
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008103
Orphan claim re-pointed
Claims processor
CLM-404633 → UHC-19228-66 (Deborah Day)
Member id
UHC-19228-66
Confidence
1
Method
probabilistic
MBR-007095CLM-404633
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008104
Orphan claim re-pointed
Claims processor
CLM-416461 → UHC-16686-90 (Jonathan Mason)
Member id
UHC-16686-90
Confidence
1
Method
probabilistic
MBR-006335CLM-416461
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008105
Orphan claim re-pointed
Claims processor
CLM-419286 → UHC-03266-71 (Amber Munoz)
Member id
UHC-03266-71
Confidence
1
Method
probabilistic
MBR-011086CLM-419286
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008106
Orphan claim re-pointed
Claims processor
CLM-419139 → UHC-31227-73 (Keith Berry)
Member id
UHC-31227-73
Confidence
1
Method
probabilistic
MBR-020622CLM-419139
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008107
Orphan claim re-pointed
Claims processor
CLM-407086 → UHC-44422-88 (Ralph Daniels)
Member id
UHC-44422-88
Confidence
1
Method
probabilistic
MBR-000036CLM-407086
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008108
Orphan claim re-pointed
Claims processor
CLM-408255 → UHC-95675-57 (Kayla Chen)
Member id
UHC-95675-57
Confidence
1
Method
probabilistic
MBR-001335CLM-408255
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008109
Orphan claim re-pointed
Claims processor
CLM-404185 → UHC-37788-27 (Melissa Tran)
Member id
UHC-37788-27
Confidence
1
Method
probabilistic
MBR-000200CLM-404185
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008110
Orphan claim re-pointed
Claims processor
CLM-428378 → UHC-91491-21 (Cheryl Bradley)
Member id
UHC-91491-21
Confidence
0.93
Method
probabilistic
MBR-012550CLM-428378
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008111
Orphan claim re-pointed
Claims processor
CLM-402793 → UHC-16351-42 (Daniel Rios)
Member id
UHC-16351-42
Confidence
1
Method
probabilistic
MBR-039306CLM-402793
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008112
Orphan claim re-pointed
Claims processor
CLM-417360 → UHC-20211-16 (Diane Kim)
Member id
UHC-20211-16
Confidence
1
Method
probabilistic
MBR-002815CLM-417360
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008113
Orphan claim re-pointed
Claims processor
CLM-405192 → UHC-46402-70 (Benjamin Hunt)
Member id
UHC-46402-70
Confidence
1
Method
probabilistic
MBR-021931CLM-405192
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008114
Orphan claim re-pointed
Claims processor
CLM-404535 → UHC-06069-32 (Sofia Lynch)
Member id
UHC-06069-32
Confidence
1
Method
probabilistic
MBR-016391CLM-404535
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008115
Orphan claim re-pointed
Claims processor
CLM-426764 → UHC-82369-83 (Katherine Bryant)
Member id
UHC-82369-83
Confidence
1
Method
probabilistic
MBR-035448CLM-426764
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008116
Orphan claim re-pointed
Claims processor
CLM-405003 → UHC-93428-71 (Carl Rihards)
Member id
UHC-93428-71
Confidence
0.99
Method
probabilistic
MBR-005038CLM-405003
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008117
Orphan claim re-pointed
Claims processor
CLM-410338 → UHC-62319-26 (Evelyn McDonald)
Member id
UHC-62319-26
Confidence
1
Method
probabilistic
MBR-015345CLM-410338
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008118
Orphan claim re-pointed
Claims processor
CLM-431092 → UHC-97823-17 (Beverly Brown)
Member id
UHC-97823-17
Confidence
1
Method
probabilistic
MBR-030738CLM-431092
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008119
Orphan claim re-pointed
Claims processor
CLM-409382 → UHC-22854-38 (Anna Carlson)
Member id
UHC-22854-38
Confidence
1
Method
probabilistic
MBR-005477CLM-409382
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008120
Orphan claim re-pointed
Claims processor
CLM-402318 → UHC-64640-18 (Laura Alvarado)
Member id
UHC-64640-18
Confidence
0.97
Method
deterministic
MBR-025866CLM-402318
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008121
Orphan claim re-pointed
Claims processor
CLM-402689 → UHC-46381-97 (Madison Jones)
Member id
UHC-46381-97
Confidence
0.99
Method
probabilistic
MBR-032128CLM-402689
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008122
Orphan claim re-pointed
Claims processor
CLM-403017 → UHC-61543-39 (Nancy Vazquez)
Member id
UHC-61543-39
Confidence
0.99
Method
probabilistic
MBR-008493CLM-403017
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008123
Orphan claim re-pointed
Claims processor
CLM-408638 → UHC-82440-56 (Lori Dominguez)
Member id
UHC-82440-56
Confidence
0.97
Method
deterministic
MBR-036622CLM-408638
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008124
Orphan claim re-pointed
Claims processor
CLM-403516 → UHC-32690-49 (Becky West)
Member id
UHC-32690-49
Confidence
1
Method
probabilistic
MBR-034708CLM-403516
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008125
Orphan claim re-pointed
Claims processor
CLM-426818 → UHC-17778-93 (Stephanie Ward)
Member id
UHC-17778-93
Confidence
0.98
Method
probabilistic
MBR-008000CLM-426818
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008126
Orphan claim re-pointed
Claims processor
CLM-412172 → UHC-97895-36 (Barbara Gilbert)
Member id
UHC-97895-36
Confidence
0.97
Method
deterministic
MBR-042429CLM-412172
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008127
Orphan claim re-pointed
Claims processor
CLM-402178 → UHC-92206-60 (Arthur Reynolds)
Member id
UHC-92206-60
Confidence
1
Method
probabilistic
MBR-013279CLM-402178
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008128
Orphan claim re-pointed
Claims processor
CLM-432374 → UHC-12963-51 (Debra Aguilar)
Member id
UHC-12963-51
Confidence
0.97
Method
deterministic
MBR-012389CLM-432374
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008129
Orphan claim re-pointed
Claims processor
CLM-426165 → UHC-46118-23 (Natalie Alvarado)
Member id
UHC-46118-23
Confidence
1
Method
probabilistic
MBR-035791CLM-426165
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008130
Orphan claim re-pointed
Claims processor
CLM-426584 → UHC-69270-12 (Stephen Alvarado)
Member id
UHC-69270-12
Confidence
1
Method
probabilistic
MBR-001966CLM-426584
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008131
Orphan claim re-pointed
Claims processor
CLM-429552 → UHC-53608-54 (Anna Harvey)
Member id
UHC-53608-54
Confidence
1
Method
probabilistic
MBR-019852CLM-429552
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008132
Orphan claim re-pointed
Claims processor
CLM-404161 → UHC-75872-76 (Peter Li)
Member id
UHC-75872-76
Confidence
1
Method
probabilistic
MBR-001422CLM-404161
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008133
Orphan claim re-pointed
Claims processor
CLM-418083 → UHC-77350-19 (Laura Banks)
Member id
UHC-77350-19
Confidence
0.97
Method
deterministic
MBR-035949CLM-418083
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008134
Orphan claim re-pointed
Claims processor
CLM-427825 → UHC-64152-85 (Donna Ramos)
Member id
UHC-64152-85
Confidence
1
Method
probabilistic
MBR-027937CLM-427825
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008135
Orphan claim re-pointed
Claims processor
CLM-404653 → UHC-77455-70 (Hannah Wood)
Member id
UHC-77455-70
Confidence
1
Method
probabilistic
MBR-001591CLM-404653
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008136
Orphan claim re-pointed
Claims processor
CLM-404710 → UHC-28560-68 (Charles Rice)
Member id
UHC-28560-68
Confidence
1
Method
probabilistic
MBR-006164CLM-404710
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008137
Orphan claim re-pointed
Claims processor
CLM-411091 → UHC-97681-70 (Mari Hernandez)
Member id
UHC-97681-70
Confidence
0.99
Method
probabilistic
MBR-037737CLM-411091
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008138
Orphan claim re-pointed
Claims processor
CLM-429536 → UHC-91248-73 (Arthur Vasquez)
Member id
UHC-91248-73
Confidence
0.99
Method
probabilistic
MBR-003730CLM-429536
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008139
Orphan claim re-pointed
Claims processor
CLM-411488 → UHC-31330-62 (Joe Adams)
Member id
UHC-31330-62
Confidence
1
Method
probabilistic
MBR-022403CLM-411488
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 136 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.