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-001990
Orphan claim re-pointed
Claims processor
CLM-411709 → UHC-16569-19 (Anthony Carr)
Member id
UHC-16569-19
Confidence
1
Method
probabilistic
MBR-005129CLM-411709
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001991
Orphan claim re-pointed
Claims processor
CLM-417644 → UHC-96404-93 (Diana Bailey)
Member id
UHC-96404-93
Confidence
1
Method
probabilistic
MBR-011801CLM-417644
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001992
Orphan claim re-pointed
Claims processor
CLM-417477 → UHC-63138-71 (Jose Reid)
Member id
UHC-63138-71
Confidence
0.97
Method
deterministic
MBR-029706CLM-417477
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001993
Orphan claim re-pointed
Claims processor
CLM-421224 → UHC-96485-89 (Logan Howard)
Member id
UHC-96485-89
Confidence
1
Method
probabilistic
MBR-038349CLM-421224
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001994
Orphan claim re-pointed
Claims processor
CLM-407594 → UHC-41260-98 (Betty Tucker)
Member id
UHC-41260-98
Confidence
0.94
Method
probabilistic
MBR-013413CLM-407594
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001995
Orphan claim re-pointed
Claims processor
CLM-413056 → UHC-60527-88 (Judy Harper)
Member id
UHC-60527-88
Confidence
0.97
Method
deterministic
MBR-034808CLM-413056
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001996
Orphan claim re-pointed
Claims processor
CLM-412759 → UHC-55265-39 (Jerry Porter)
Member id
UHC-55265-39
Confidence
1
Method
probabilistic
MBR-039021CLM-412759
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001997
Orphan claim re-pointed
Claims processor
CLM-411998 → UHC-66353-78 (Lisa Walker)
Member id
UHC-66353-78
Confidence
1
Method
probabilistic
MBR-036481CLM-411998
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001998
Orphan claim re-pointed
Claims processor
CLM-402639 → UHC-32697-71 (Gregory Richardson)
Member id
UHC-32697-71
Confidence
1
Method
probabilistic
MBR-006880CLM-402639
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001999
Orphan claim re-pointed
Claims processor
CLM-405644 → UHC-44797-11 (Stephen Chavez)
Member id
UHC-44797-11
Confidence
0.97
Method
deterministic
MBR-005295CLM-405644
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002000
Orphan claim re-pointed
Claims processor
CLM-415042 → UHC-06443-59 (Yuki Russell)
Member id
UHC-06443-59
Confidence
1
Method
probabilistic
MBR-010695CLM-415042
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002001
Orphan claim re-pointed
Claims processor
CLM-410700 → UHC-84467-90 (Brandon Armstrong)
Member id
UHC-84467-90
Confidence
0.93
Method
probabilistic
MBR-016950CLM-410700
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002002
Orphan claim re-pointed
Claims processor
CLM-426689 → UHC-04955-08 (Eric Foster)
Member id
UHC-04955-08
Confidence
1
Method
probabilistic
MBR-012910CLM-426689
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002003
Orphan claim re-pointed
Claims processor
CLM-422470 → UHC-15077-93 (Russell Richards)
Member id
UHC-15077-93
Confidence
1
Method
probabilistic
MBR-030177CLM-422470
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002004
Orphan claim re-pointed
Claims processor
CLM-415565 → UHC-26376-31 (Fatima Vasquez)
Member id
UHC-26376-31
Confidence
0.94
Method
probabilistic
MBR-015909CLM-415565
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002005
Orphan claim re-pointed
Claims processor
CLM-419608 → UHC-09077-92 (Isabella Wood)
Member id
UHC-09077-92
Confidence
0.97
Method
deterministic
MBR-006638CLM-419608
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002006
Orphan claim re-pointed
Claims processor
CLM-425828 → UHC-24006-94 (Katherine Coleman)
Member id
UHC-24006-94
Confidence
0.93
Method
probabilistic
MBR-031362CLM-425828
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002007
Orphan claim re-pointed
Claims processor
CLM-404056 → UHC-63165-77 (Lawrence Ellis)
Member id
UHC-63165-77
Confidence
1.00
Method
probabilistic
MBR-012537CLM-404056
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002008
Orphan claim re-pointed
Claims processor
CLM-429469 → UHC-32314-83 (Martha West)
Member id
UHC-32314-83
Confidence
1
Method
probabilistic
MBR-011472CLM-429469
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002009
Orphan claim re-pointed
Claims processor
CLM-404339 → UHC-95183-75 (Madison Armstrong)
Member id
UHC-95183-75
Confidence
1
Method
probabilistic
MBR-004451CLM-404339
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002010
Orphan claim re-pointed
Claims processor
CLM-402449 → UHC-10340-59 (Elizabeth Freeman)
Member id
UHC-10340-59
Confidence
1
Method
probabilistic
MBR-009475CLM-402449
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002011
Orphan claim re-pointed
Claims processor
CLM-424543 → UHC-62518-63 (Judy Walker)
Member id
UHC-62518-63
Confidence
1
Method
probabilistic
MBR-003400CLM-424543
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002012
Orphan claim re-pointed
Claims processor
CLM-431309 → UHC-46316-68 (Keith Herrera)
Member id
UHC-46316-68
Confidence
0.97
Method
deterministic
MBR-000391CLM-431309
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002013
Orphan claim re-pointed
Claims processor
CLM-422139 → UHC-96670-88 (Danielle Price)
Member id
UHC-96670-88
Confidence
1
Method
probabilistic
MBR-010842CLM-422139
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002014
Orphan claim re-pointed
Claims processor
CLM-418357 → UHC-72131-03 (Kelly Richardson)
Member id
UHC-72131-03
Confidence
1
Method
probabilistic
MBR-000086CLM-418357
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002015
Orphan claim re-pointed
Claims processor
CLM-412299 → UHC-48583-08 (Lawrence Watson)
Member id
UHC-48583-08
Confidence
1
Method
probabilistic
MBR-008125CLM-412299
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002016
Orphan claim re-pointed
Claims processor
CLM-416348 → UHC-43813-38 (Arjun Anderson)
Member id
UHC-43813-38
Confidence
1
Method
probabilistic
MBR-040262CLM-416348
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002017
Orphan claim re-pointed
Claims processor
CLM-403187 → UHC-21353-27 (Yuki Herrera)
Member id
UHC-21353-27
Confidence
0.94
Method
probabilistic
MBR-028746CLM-403187
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002018
Orphan claim re-pointed
Claims processor
CLM-431050 → UHC-08508-41 (Lawrence Hansen)
Member id
UHC-08508-41
Confidence
1
Method
probabilistic
MBR-042294CLM-431050
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002019
Orphan claim re-pointed
Claims processor
CLM-414216 → UHC-69077-72 (Anna Kennedy)
Member id
UHC-69077-72
Confidence
0.97
Method
deterministic
MBR-006179CLM-414216
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002020
Orphan claim re-pointed
Claims processor
CLM-409441 → UHC-71182-79 (Cynthia Castro)
Member id
UHC-71182-79
Confidence
0.99
Method
probabilistic
MBR-007156CLM-409441
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002021
Orphan claim re-pointed
Claims processor
CLM-421886 → UHC-65472-14 (Brittany Fuller)
Member id
UHC-65472-14
Confidence
0.87
Method
probabilistic
MBR-023176CLM-421886
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002022
Orphan claim re-pointed
Claims processor
CLM-406467 → UHC-85549-30 (Elizabeth Fox)
Member id
UHC-85549-30
Confidence
1
Method
probabilistic
MBR-006039CLM-406467
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002023
Orphan claim re-pointed
Claims processor
CLM-424446 → UHC-87508-67 (Angela Wheeler)
Member id
UHC-87508-67
Confidence
0.93
Method
probabilistic
MBR-011169CLM-424446
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002024
Orphan claim re-pointed
Claims processor
CLM-427195 → UHC-55154-36 (William Rose)
Member id
UHC-55154-36
Confidence
1
Method
probabilistic
MBR-019373CLM-427195
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002025
Orphan claim re-pointed
Claims processor
CLM-418936 → UHC-17261-98 (Eugene Fuller)
Member id
UHC-17261-98
Confidence
1
Method
probabilistic
MBR-020480CLM-418936
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002026
Orphan claim re-pointed
Claims processor
CLM-403748 → UHC-93359-73 (Henry Little)
Member id
UHC-93359-73
Confidence
1
Method
probabilistic
MBR-001424CLM-403748
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002027
Orphan claim re-pointed
Claims processor
CLM-407645 → UHC-42761-74 (Diana Ryan)
Member id
UHC-42761-74
Confidence
1
Method
probabilistic
MBR-029922CLM-407645
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002028
Orphan claim re-pointed
Claims processor
CLM-425397 → UHC-27170-07 (Omar Castro)
Member id
UHC-27170-07
Confidence
1
Method
probabilistic
MBR-043982CLM-425397
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002029
Orphan claim re-pointed
Claims processor
CLM-421386 → UHC-60404-50 (Diae Nguyen)
Member id
UHC-60404-50
Confidence
0.99
Method
probabilistic
MBR-004786CLM-421386
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002030
Orphan claim re-pointed
Claims processor
CLM-415159 → UHC-82255-21 (Edward Garcia)
Member id
UHC-82255-21
Confidence
1
Method
probabilistic
MBR-010205CLM-415159
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002031
Orphan claim re-pointed
Claims processor
CLM-424326 → UHC-24628-03 (Marcus Myers)
Member id
UHC-24628-03
Confidence
1
Method
probabilistic
MBR-007272CLM-424326
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002032
Orphan claim re-pointed
Claims processor
CLM-420388 → UHC-35643-74 (Mary Garrett)
Member id
UHC-35643-74
Confidence
1
Method
probabilistic
MBR-002377CLM-420388
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002033
Orphan claim re-pointed
Claims processor
CLM-403299 → UHC-56034-99 (Daniel Santiago)
Member id
UHC-56034-99
Confidence
0.99
Method
probabilistic
MBR-012676CLM-403299
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002034
Orphan claim re-pointed
Claims processor
CLM-420462 → UHC-71408-63 (Patrick Valdez)
Member id
UHC-71408-63
Confidence
0.94
Method
probabilistic
MBR-000400CLM-420462
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002035
Orphan claim re-pointed
Claims processor
CLM-432347 → UHC-34112-33 (Jeremy Scott)
Member id
UHC-34112-33
Confidence
0.97
Method
deterministic
MBR-005554CLM-432347
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002036
Orphan claim re-pointed
Claims processor
CLM-426334 → UHC-89853-24 (Alexis Crawfford)
Member id
UHC-89853-24
Confidence
0.99
Method
probabilistic
MBR-038905CLM-426334
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002037
Orphan claim re-pointed
Claims processor
CLM-426769 → UHC-35590-27 (Megan Sandoval)
Member id
UHC-35590-27
Confidence
1
Method
probabilistic
MBR-010326CLM-426769
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002038
Orphan claim re-pointed
Claims processor
CLM-421752 → UHC-84718-34 (Linda Johnson)
Member id
UHC-84718-34
Confidence
0.99
Method
probabilistic
MBR-032292CLM-421752
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002039
Orphan claim re-pointed
Claims processor
CLM-423945 → UHC-49852-21 (Sandra Reed)
Member id
UHC-49852-21
Confidence
1
Method
probabilistic
MBR-007012CLM-423945
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 14 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.