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-008190
Orphan claim re-pointed
Claims processor
CLM-418412 → UHC-64354-17 (Judy Soto)
Member id
UHC-64354-17
Confidence
1
Method
probabilistic
MBR-000209CLM-418412
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008191
Orphan claim re-pointed
Claims processor
CLM-414894 → UHC-01376-40 (Lisa Nunez)
Member id
UHC-01376-40
Confidence
1
Method
probabilistic
MBR-026484CLM-414894
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008192
Orphan claim re-pointed
Claims processor
CLM-405526 → UHC-00298-63 (Danielle Walsh)
Member id
UHC-00298-63
Confidence
1
Method
probabilistic
MBR-004008CLM-405526
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008193
Orphan claim re-pointed
Claims processor
CLM-421599 → UHC-89226-72 (Jacob Ramirez)
Member id
UHC-89226-72
Confidence
1
Method
probabilistic
MBR-020000CLM-421599
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008194
Orphan claim re-pointed
Claims processor
CLM-408677 → UHC-20074-87 (Janice Burton)
Member id
UHC-20074-87
Confidence
1
Method
probabilistic
MBR-029235CLM-408677
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008195
Orphan claim re-pointed
Claims processor
CLM-408975 → UHC-27676-63 (Nicole Sullivan)
Member id
UHC-27676-63
Confidence
0.97
Method
deterministic
MBR-029876CLM-408975
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008196
Orphan claim re-pointed
Claims processor
CLM-428529 → UHC-27116-73 (Maria Wagner)
Member id
UHC-27116-73
Confidence
0.97
Method
deterministic
MBR-001086CLM-428529
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008197
Orphan claim re-pointed
Claims processor
CLM-400759 → UHC-42668-04 (Kenneth Stewart)
Member id
UHC-42668-04
Confidence
1
Method
probabilistic
MBR-021203CLM-400759
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008198
Orphan claim re-pointed
Claims processor
CLM-401728 → UHC-85766-54 (Ethan Le)
Member id
UHC-85766-54
Confidence
1
Method
probabilistic
MBR-007125CLM-401728
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008199
Orphan claim re-pointed
Claims processor
CLM-429657 → UHC-11052-08 (Nancy Watkins)
Member id
UHC-11052-08
Confidence
1
Method
probabilistic
MBR-035796CLM-429657
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008200
Orphan claim re-pointed
Claims processor
CLM-408659 → UHC-69557-31 (Roger Morrison)
Member id
UHC-69557-31
Confidence
1
Method
probabilistic
MBR-003053CLM-408659
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008201
Orphan claim re-pointed
Claims processor
CLM-404554 → UHC-68737-10 (Julie Fields)
Member id
UHC-68737-10
Confidence
0.97
Method
deterministic
MBR-024360CLM-404554
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008202
Orphan claim re-pointed
Claims processor
CLM-429291 → UHC-01150-30 (Amanda Price)
Member id
UHC-01150-30
Confidence
1
Method
probabilistic
MBR-036995CLM-429291
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008203
Orphan claim re-pointed
Claims processor
CLM-410094 → UHC-56018-98 (Emily Nguyen)
Member id
UHC-56018-98
Confidence
1
Method
probabilistic
MBR-003371CLM-410094
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008204
Orphan claim re-pointed
Claims processor
CLM-427394 → UHC-06530-77 (Philip Wells)
Member id
UHC-06530-77
Confidence
1
Method
probabilistic
MBR-033746CLM-427394
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008205
Orphan claim re-pointed
Claims processor
CLM-404968 → UHC-50684-94 (Sam Miller)
Member id
UHC-50684-94
Confidence
1
Method
probabilistic
MBR-006240CLM-404968
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008206
Orphan claim re-pointed
Claims processor
CLM-420635 → UHC-37443-96 (Camila Hart)
Member id
UHC-37443-96
Confidence
1
Method
probabilistic
MBR-010163CLM-420635
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008207
Orphan claim re-pointed
Claims processor
CLM-406792 → UHC-89971-19 (Diana Estrada)
Member id
UHC-89971-19
Confidence
1
Method
probabilistic
MBR-027016CLM-406792
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008208
Orphan claim re-pointed
Claims processor
CLM-421369 → UHC-91386-44 (Jeffrey Baker)
Member id
UHC-91386-44
Confidence
1
Method
probabilistic
MBR-016413CLM-421369
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008209
Orphan claim re-pointed
Claims processor
CLM-416951 → UHC-99986-31 (Angela Delgado)
Member id
UHC-99986-31
Confidence
1
Method
probabilistic
MBR-029990CLM-416951
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008210
Orphan claim re-pointed
Claims processor
CLM-421527 → UHC-23118-53 (Mari Montgomery)
Member id
UHC-23118-53
Confidence
1
Method
probabilistic
MBR-012795CLM-421527
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008211
Orphan claim re-pointed
Claims processor
CLM-418397 → UHC-50522-01 (Frank Watkins)
Member id
UHC-50522-01
Confidence
1
Method
probabilistic
MBR-020657CLM-418397
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008212
Orphan claim re-pointed
Claims processor
CLM-403393 → UHC-56451-44 (Henry Hunter)
Member id
UHC-56451-44
Confidence
0.97
Method
deterministic
MBR-001798CLM-403393
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008213
Orphan claim re-pointed
Claims processor
CLM-403333 → UHC-81477-97 (Teresa Hayes)
Member id
UHC-81477-97
Confidence
1
Method
probabilistic
MBR-012681CLM-403333
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008214
Orphan claim re-pointed
Claims processor
CLM-431601 → UHC-83728-87 (Beverly Schultz)
Member id
UHC-83728-87
Confidence
1
Method
probabilistic
MBR-014261CLM-431601
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008215
Orphan claim re-pointed
Claims processor
CLM-401397 → UHC-52766-32 (Bryan Cruz)
Member id
UHC-52766-32
Confidence
1
Method
probabilistic
MBR-022990CLM-401397
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008216
Orphan claim re-pointed
Claims processor
CLM-417145 → UHC-10960-04 (Anna Burke)
Member id
UHC-10960-04
Confidence
1
Method
probabilistic
MBR-018737CLM-417145
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008217
Orphan claim re-pointed
Claims processor
CLM-403024 → UHC-88572-65 (Allice Wallace)
Member id
UHC-88572-65
Confidence
0.99
Method
probabilistic
MBR-022837CLM-403024
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008218
Orphan claim re-pointed
Claims processor
CLM-404198 → UHC-61850-60 (Christine Knight)
Member id
UHC-61850-60
Confidence
1
Method
probabilistic
MBR-014017CLM-404198
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008219
Orphan claim re-pointed
Claims processor
CLM-401754 → UHC-97471-75 (Pattrick Espinoza)
Member id
UHC-97471-75
Confidence
0.99
Method
probabilistic
MBR-035732CLM-401754
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008220
Orphan claim re-pointed
Claims processor
CLM-412013 → UHC-73260-83 (Samuel Adams)
Member id
UHC-73260-83
Confidence
0.85
Method
probabilistic
MBR-000656CLM-412013
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008221
Orphan claim re-pointed
Claims processor
CLM-404989 → UHC-26831-50 (Charles Lane)
Member id
UHC-26831-50
Confidence
1
Method
probabilistic
MBR-014477CLM-404989
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008222
Orphan claim re-pointed
Claims processor
CLM-406594 → UHC-02077-12 (Hiroshi Lewis)
Member id
UHC-02077-12
Confidence
1
Method
probabilistic
MBR-008672CLM-406594
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008223
Orphan claim re-pointed
Claims processor
CLM-403336 → UHC-80513-60 (Liz Robinson)
Member id
UHC-80513-60
Confidence
1
Method
probabilistic
MBR-035134CLM-403336
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008224
Orphan claim re-pointed
Claims processor
CLM-402128 → UHC-34634-77 (Emily Kennedy)
Member id
UHC-34634-77
Confidence
0.97
Method
deterministic
MBR-005460CLM-402128
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008225
Orphan claim re-pointed
Claims processor
CLM-402651 → UHC-56976-80 (Carl Rivera)
Member id
UHC-56976-80
Confidence
1
Method
probabilistic
MBR-032582CLM-402651
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008226
Orphan claim re-pointed
Claims processor
CLM-415936 → UHC-50232-64 (Billy Fuller)
Member id
UHC-50232-64
Confidence
0.95
Method
probabilistic
MBR-008452CLM-415936
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008227
Orphan claim re-pointed
Claims processor
CLM-405928 → UHC-18844-54 (Julie Peters)
Member id
UHC-18844-54
Confidence
0.85
Method
probabilistic
MBR-024184CLM-405928
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008228
Orphan claim re-pointed
Claims processor
CLM-420458 → UHC-71644-84 (Samantha Torres)
Member id
UHC-71644-84
Confidence
1
Method
probabilistic
MBR-008727CLM-420458
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008229
Orphan claim re-pointed
Claims processor
CLM-425027 → UHC-68558-75 (Jeremy Henderson)
Member id
UHC-68558-75
Confidence
1
Method
probabilistic
MBR-030798CLM-425027
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008230
Orphan claim re-pointed
Claims processor
CLM-404987 → UHC-24928-35 (Christina Kennedy)
Member id
UHC-24928-35
Confidence
1
Method
probabilistic
MBR-015350CLM-404987
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008231
Orphan claim re-pointed
Claims processor
CLM-409627 → UHC-60262-09 (Virginia Rice)
Member id
UHC-60262-09
Confidence
0.89
Method
probabilistic
MBR-016873CLM-409627
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008232
Orphan claim re-pointed
Claims processor
CLM-416765 → UHC-55195-82 (Ralph Sullivan)
Member id
UHC-55195-82
Confidence
1
Method
probabilistic
MBR-020367CLM-416765
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008233
Orphan claim re-pointed
Claims processor
CLM-402053 → UHC-50527-20 (Nancy Munoz)
Member id
UHC-50527-20
Confidence
1
Method
probabilistic
MBR-010544CLM-402053
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008234
Orphan claim re-pointed
Claims processor
CLM-431090 → UHC-36805-24 (Diana Dixon)
Member id
UHC-36805-24
Confidence
0.93
Method
probabilistic
MBR-018415CLM-431090
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008235
Orphan claim re-pointed
Claims processor
CLM-405724 → UHC-87572-94 (William Simpson)
Member id
UHC-87572-94
Confidence
1
Method
probabilistic
MBR-004399CLM-405724
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008236
Orphan claim re-pointed
Claims processor
CLM-425975 → UHC-06109-86 (Willis Edward)
Member id
UHC-06109-86
Confidence
0.98
Method
probabilistic
MBR-011961CLM-425975
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008237
Orphan claim re-pointed
Claims processor
CLM-401197 → UHC-06759-45 (Nicholas Myers)
Member id
UHC-06759-45
Confidence
1
Method
probabilistic
MBR-035742CLM-401197
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008238
Orphan claim re-pointed
Claims processor
CLM-410756 → UHC-37240-26 (Robert Lynch)
Member id
UHC-37240-26
Confidence
1
Method
probabilistic
MBR-020704CLM-410756
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008239
Orphan claim re-pointed
Claims processor
CLM-402252 → UHC-28664-92 (Nancy Bennett)
Member id
UHC-28664-92
Confidence
1
Method
probabilistic
MBR-017390CLM-402252
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 138 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.