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-008340
Orphan claim re-pointed
Claims processor
CLM-406465 → UHC-73695-03 (Kathleen Moore)
Member id
UHC-73695-03
Confidence
1
Method
probabilistic
MBR-039191CLM-406465
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008341
Orphan claim re-pointed
Claims processor
CLM-423198 → UHC-37719-32 (Ralph Lynch)
Member id
UHC-37719-32
Confidence
1
Method
probabilistic
MBR-033164CLM-423198
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008342
Orphan claim re-pointed
Claims processor
CLM-422746 → UHC-73785-46 (Elizabeth Reyes)
Member id
UHC-73785-46
Confidence
1
Method
probabilistic
MBR-015705CLM-422746
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008343
Orphan claim re-pointed
Claims processor
CLM-430722 → UHC-97229-55 (Diego Weaver)
Member id
UHC-97229-55
Confidence
1
Method
probabilistic
MBR-033646CLM-430722
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008344
Orphan claim re-pointed
Claims processor
CLM-418815 → UHC-89046-92 (Richard Boyd)
Member id
UHC-89046-92
Confidence
1
Method
probabilistic
MBR-002158CLM-418815
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008345
Orphan claim re-pointed
Claims processor
CLM-422822 → UHC-32163-31 (Terry Olson)
Member id
UHC-32163-31
Confidence
0.97
Method
deterministic
MBR-038806CLM-422822
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008346
Orphan claim re-pointed
Claims processor
CLM-416320 → UHC-50247-35 (Gabriel Carr)
Member id
UHC-50247-35
Confidence
1
Method
probabilistic
MBR-019208CLM-416320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008347
Orphan claim re-pointed
Claims processor
CLM-413438 → UHC-35719-69 (Alan Sanchez)
Member id
UHC-35719-69
Confidence
0.97
Method
deterministic
MBR-008705CLM-413438
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008348
Orphan claim re-pointed
Claims processor
CLM-416841 → UHC-62023-38 (Kimberly Henry)
Member id
UHC-62023-38
Confidence
0.97
Method
deterministic
MBR-005275CLM-416841
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008349
Orphan claim re-pointed
Claims processor
CLM-421894 → UHC-62313-89 (Ethan Jackson)
Member id
UHC-62313-89
Confidence
1
Method
probabilistic
MBR-000104CLM-421894
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008350
Orphan claim re-pointed
Claims processor
CLM-400494 → UHC-26457-27 (Amanda Marshall)
Member id
UHC-26457-27
Confidence
0.99
Method
probabilistic
MBR-020501CLM-400494
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008351
Orphan claim re-pointed
Claims processor
CLM-428790 → UHC-26758-34 (Christina Gonzalez)
Member id
UHC-26758-34
Confidence
1
Method
probabilistic
MBR-026475CLM-428790
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008352
Orphan claim re-pointed
Claims processor
CLM-405255 → UHC-12260-84 (Alexis Washington)
Member id
UHC-12260-84
Confidence
0.94
Method
probabilistic
MBR-037635CLM-405255
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008353
Orphan claim re-pointed
Claims processor
CLM-408535 → UHC-70356-45 (Kathy Matthews)
Member id
UHC-70356-45
Confidence
1
Method
probabilistic
MBR-032610CLM-408535
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008354
Orphan claim re-pointed
Claims processor
CLM-418117 → UHC-49734-04 (Steven Henry)
Member id
UHC-49734-04
Confidence
1
Method
probabilistic
MBR-030346CLM-418117
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008355
Orphan claim re-pointed
Claims processor
CLM-430033 → UHC-85512-04 (Keith Rogers)
Member id
UHC-85512-04
Confidence
1
Method
probabilistic
MBR-007435CLM-430033
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008356
Orphan claim re-pointed
Claims processor
CLM-419293 → UHC-49759-88 (Grace Henry)
Member id
UHC-49759-88
Confidence
0.94
Method
probabilistic
MBR-010149CLM-419293
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008357
Orphan claim re-pointed
Claims processor
CLM-406602 → UHC-82645-48 (Douglas Garza)
Member id
UHC-82645-48
Confidence
1
Method
probabilistic
MBR-002425CLM-406602
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008358
Orphan claim re-pointed
Claims processor
CLM-407251 → UHC-73584-46 (Diana Cooper)
Member id
UHC-73584-46
Confidence
1
Method
probabilistic
MBR-013232CLM-407251
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008359
Orphan claim re-pointed
Claims processor
CLM-408200 → UHC-55258-87 (Theresa Torres)
Member id
UHC-55258-87
Confidence
0.97
Method
deterministic
MBR-002788CLM-408200
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008360
Orphan claim re-pointed
Claims processor
CLM-412784 → UHC-81624-09 (Christina Herrera)
Member id
UHC-81624-09
Confidence
1
Method
probabilistic
MBR-023695CLM-412784
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008361
Orphan claim re-pointed
Claims processor
CLM-400917 → UHC-48607-37 (Carl Cruz)
Member id
UHC-48607-37
Confidence
1
Method
probabilistic
MBR-027313CLM-400917
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008362
Orphan claim re-pointed
Claims processor
CLM-411168 → UHC-74741-25 (Jose Morrison)
Member id
UHC-74741-25
Confidence
1
Method
probabilistic
MBR-008883CLM-411168
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008363
Orphan claim re-pointed
Claims processor
CLM-418558 → UHC-12369-48 (Lauren Graham)
Member id
UHC-12369-48
Confidence
0.99
Method
probabilistic
MBR-023222CLM-418558
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008364
Orphan claim re-pointed
Claims processor
CLM-418603 → UHC-12777-98 (Cynthia Gray)
Member id
UHC-12777-98
Confidence
1
Method
probabilistic
MBR-011635CLM-418603
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008365
Orphan claim re-pointed
Claims processor
CLM-412411 → UHC-85895-32 (Andrew Foster)
Member id
UHC-85895-32
Confidence
0.98
Method
probabilistic
MBR-010862CLM-412411
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008366
Orphan claim re-pointed
Claims processor
CLM-412926 → UHC-81455-82 (Sharon Cooper)
Member id
UHC-81455-82
Confidence
0.98
Method
probabilistic
MBR-007657CLM-412926
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008367
Orphan claim re-pointed
Claims processor
CLM-405055 → UHC-82910-48 (Ricard Bailey)
Member id
UHC-82910-48
Confidence
0.99
Method
probabilistic
MBR-016067CLM-405055
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008368
Orphan claim re-pointed
Claims processor
CLM-429114 → UHC-50353-26 (Santiago Stone)
Member id
UHC-50353-26
Confidence
1
Method
probabilistic
MBR-006505CLM-429114
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008369
Orphan claim re-pointed
Claims processor
CLM-413958 → UHC-20227-17 (Diana Hamilton)
Member id
UHC-20227-17
Confidence
1
Method
probabilistic
MBR-002135CLM-413958
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008370
Orphan claim re-pointed
Claims processor
CLM-415488 → UHC-48738-18 (Rebecca Hart)
Member id
UHC-48738-18
Confidence
1
Method
probabilistic
MBR-018635CLM-415488
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008371
Orphan claim re-pointed
Claims processor
CLM-419590 → UHC-93478-47 (Nathan Robertson)
Member id
UHC-93478-47
Confidence
1
Method
probabilistic
MBR-013711CLM-419590
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008372
Orphan claim re-pointed
Claims processor
CLM-426452 → UHC-13952-43 (Margaret Weaver)
Member id
UHC-13952-43
Confidence
1
Method
probabilistic
MBR-000298CLM-426452
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008373
Orphan claim re-pointed
Claims processor
CLM-428948 → UHC-39871-55 (Vincent Castillo)
Member id
UHC-39871-55
Confidence
1
Method
probabilistic
MBR-021927CLM-428948
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008374
Orphan claim re-pointed
Claims processor
CLM-413239 → UHC-56193-25 (Joseph Moore)
Member id
UHC-56193-25
Confidence
0.97
Method
deterministic
MBR-038386CLM-413239
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008375
Orphan claim re-pointed
Claims processor
CLM-430639 → UHC-26050-17 (Beverly Davis)
Member id
UHC-26050-17
Confidence
1
Method
probabilistic
MBR-007037CLM-430639
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008376
Orphan claim re-pointed
Claims processor
CLM-409526 → UHC-43618-30 (Elizabeth Greene)
Member id
UHC-43618-30
Confidence
0.99
Method
probabilistic
MBR-008656CLM-409526
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008377
Orphan claim re-pointed
Claims processor
CLM-403487 → UHC-51240-43 (Camila Olson)
Member id
UHC-51240-43
Confidence
1
Method
probabilistic
MBR-006706CLM-403487
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008378
Orphan claim re-pointed
Claims processor
CLM-411093 → UHC-82957-73 (Luis Garcia)
Member id
UHC-82957-73
Confidence
0.99
Method
probabilistic
MBR-012889CLM-411093
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008379
Orphan claim re-pointed
Claims processor
CLM-429699 → UHC-51125-18 (Douglas Banks)
Member id
UHC-51125-18
Confidence
0.93
Method
probabilistic
MBR-008629CLM-429699
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008380
Orphan claim re-pointed
Claims processor
CLM-428758 → UHC-13138-62 (Gabriel Sanders)
Member id
UHC-13138-62
Confidence
1.00
Method
probabilistic
MBR-013214CLM-428758
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008381
Orphan claim re-pointed
Claims processor
CLM-400869 → UHC-88462-16 (Frances Bennett)
Member id
UHC-88462-16
Confidence
0.97
Method
deterministic
MBR-006188CLM-400869
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008382
Orphan claim re-pointed
Claims processor
CLM-403269 → UHC-32602-43 (Joe Hunter)
Member id
UHC-32602-43
Confidence
1
Method
probabilistic
MBR-035611CLM-403269
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008383
Orphan claim re-pointed
Claims processor
CLM-410116 → UHC-23636-43 (Cheryl Vazquez)
Member id
UHC-23636-43
Confidence
1
Method
probabilistic
MBR-018548CLM-410116
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008384
Orphan claim re-pointed
Claims processor
CLM-425339 → UHC-09489-36 (George Bishop)
Member id
UHC-09489-36
Confidence
1
Method
probabilistic
MBR-004671CLM-425339
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008385
Orphan claim re-pointed
Claims processor
CLM-428274 → UHC-56282-29 (Pamela Edwards)
Member id
UHC-56282-29
Confidence
0.97
Method
deterministic
MBR-016032CLM-428274
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008386
Orphan claim re-pointed
Claims processor
CLM-431591 → UHC-19660-26 (Ethan Kim)
Member id
UHC-19660-26
Confidence
1
Method
probabilistic
MBR-007993CLM-431591
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008387
Orphan claim re-pointed
Claims processor
CLM-416704 → UHC-09067-17 (Maria Robinson)
Member id
UHC-09067-17
Confidence
0.97
Method
deterministic
MBR-038924CLM-416704
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008388
Orphan claim re-pointed
Claims processor
CLM-431336 → UHC-56910-92 (Brian Fox)
Member id
UHC-56910-92
Confidence
1
Method
probabilistic
MBR-001264CLM-431336
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008389
Orphan claim re-pointed
Claims processor
CLM-402879 → UHC-33407-72 (Dylan Taylor)
Member id
UHC-33407-72
Confidence
0.97
Method
deterministic
MBR-042563CLM-402879
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 141 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.