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-008390
Orphan claim re-pointed
Claims processor
CLM-407512 → UHC-03885-49 (Larry Walker)
Member id
UHC-03885-49
Confidence
1
Method
probabilistic
MBR-042383CLM-407512
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008391
Orphan claim re-pointed
Claims processor
CLM-406448 → UHC-14837-83 (Heather Estrada)
Member id
UHC-14837-83
Confidence
1
Method
probabilistic
MBR-031240CLM-406448
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008392
Orphan claim re-pointed
Claims processor
CLM-410757 → UHC-87313-66 (Shirley Armstrong)
Member id
UHC-87313-66
Confidence
1
Method
probabilistic
MBR-000193CLM-410757
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008393
Orphan claim re-pointed
Claims processor
CLM-431425 → UHC-19387-98 (Marcus Cook)
Member id
UHC-19387-98
Confidence
1
Method
probabilistic
MBR-002748CLM-431425
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008394
Orphan claim re-pointed
Claims processor
CLM-412805 → UHC-97157-40 (Brittany Hernandez)
Member id
UHC-97157-40
Confidence
0.99
Method
probabilistic
MBR-020669CLM-412805
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008395
Orphan claim re-pointed
Claims processor
CLM-431839 → UHC-59847-77 (Mason Mason)
Member id
UHC-59847-77
Confidence
0.97
Method
deterministic
MBR-027102CLM-431839
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008396
Orphan claim re-pointed
Claims processor
CLM-426001 → UHC-96758-59 (Jason Price)
Member id
UHC-96758-59
Confidence
0.97
Method
deterministic
MBR-000456CLM-426001
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008397
Orphan claim re-pointed
Claims processor
CLM-400040 → UHC-74188-59 (Logan Knight)
Member id
UHC-74188-59
Confidence
0.97
Method
deterministic
MBR-015189CLM-400040
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008398
Orphan claim re-pointed
Claims processor
CLM-409122 → UHC-55015-60 (Omar Green)
Member id
UHC-55015-60
Confidence
0.97
Method
deterministic
MBR-034719CLM-409122
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008399
Orphan claim re-pointed
Claims processor
CLM-416449 → UHC-83645-72 (Ruth Peterson)
Member id
UHC-83645-72
Confidence
1
Method
probabilistic
MBR-022862CLM-416449
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008400
Orphan claim re-pointed
Claims processor
CLM-427457 → UHC-15113-79 (Steve Wallace)
Member id
UHC-15113-79
Confidence
1
Method
probabilistic
MBR-035405CLM-427457
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008401
Orphan claim re-pointed
Claims processor
CLM-415894 → UHC-36112-57 (Diego Lane)
Member id
UHC-36112-57
Confidence
1
Method
probabilistic
MBR-005983CLM-415894
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008402
Orphan claim re-pointed
Claims processor
CLM-420824 → UHC-93150-43 (George Foster)
Member id
UHC-93150-43
Confidence
1
Method
probabilistic
MBR-007737CLM-420824
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008403
Orphan claim re-pointed
Claims processor
CLM-411784 → UHC-42370-87 (Barbara Yang)
Member id
UHC-42370-87
Confidence
0.93
Method
probabilistic
MBR-011371CLM-411784
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008404
Orphan claim re-pointed
Claims processor
CLM-402951 → UHC-52045-15 (Linda Garrett)
Member id
UHC-52045-15
Confidence
0.97
Method
deterministic
MBR-001868CLM-402951
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008405
Orphan claim re-pointed
Claims processor
CLM-415971 → UHC-67865-24 (Jennifer Hayes)
Member id
UHC-67865-24
Confidence
0.97
Method
deterministic
MBR-019439CLM-415971
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008406
Orphan claim re-pointed
Claims processor
CLM-401988 → UHC-78063-85 (Eugene McCoy)
Member id
UHC-78063-85
Confidence
1
Method
probabilistic
MBR-007036CLM-401988
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008407
Orphan claim re-pointed
Claims processor
CLM-414303 → UHC-60314-10 (Kathleen Knight)
Member id
UHC-60314-10
Confidence
1
Method
probabilistic
MBR-030239CLM-414303
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008408
Orphan claim re-pointed
Claims processor
CLM-406806 → UHC-97214-71 (Patricia Hart)
Member id
UHC-97214-71
Confidence
0.94
Method
probabilistic
MBR-034096CLM-406806
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008409
Orphan claim re-pointed
Claims processor
CLM-410580 → UHC-16606-32 (Jack Henderson)
Member id
UHC-16606-32
Confidence
1
Method
probabilistic
MBR-013858CLM-410580
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008410
Orphan claim re-pointed
Claims processor
CLM-426305 → UHC-48314-07 (Kathryn Munoz)
Member id
UHC-48314-07
Confidence
1
Method
probabilistic
MBR-026311CLM-426305
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008411
Orphan claim re-pointed
Claims processor
CLM-418161 → UHC-41583-44 (Joseph Wong)
Member id
UHC-41583-44
Confidence
1
Method
probabilistic
MBR-007289CLM-418161
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008412
Orphan claim re-pointed
Claims processor
CLM-413300 → UHC-20506-45 (Teresa Ford)
Member id
UHC-20506-45
Confidence
1
Method
probabilistic
MBR-015307CLM-413300
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008413
Orphan claim re-pointed
Claims processor
CLM-426858 → UHC-27905-48 (Sofia Ramos)
Member id
UHC-27905-48
Confidence
0.97
Method
deterministic
MBR-039327CLM-426858
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008414
Orphan claim re-pointed
Claims processor
CLM-420647 → UHC-69144-34 (Ralph Nichols)
Member id
UHC-69144-34
Confidence
1
Method
probabilistic
MBR-004093CLM-420647
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008415
Orphan claim re-pointed
Claims processor
CLM-411668 → UHC-34779-09 (Jack Fox)
Member id
UHC-34779-09
Confidence
1
Method
probabilistic
MBR-016851CLM-411668
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008416
Orphan claim re-pointed
Claims processor
CLM-406857 → UHC-38256-64 (Thomas Sandoval)
Member id
UHC-38256-64
Confidence
1
Method
probabilistic
MBR-025915CLM-406857
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008417
Orphan claim re-pointed
Claims processor
CLM-419523 → UHC-85777-05 (Peter Castillo)
Member id
UHC-85777-05
Confidence
1
Method
probabilistic
MBR-000993CLM-419523
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008418
Orphan claim re-pointed
Claims processor
CLM-408622 → UHC-33957-43 (Kyle Vega)
Member id
UHC-33957-43
Confidence
1
Method
probabilistic
MBR-011634CLM-408622
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008419
Orphan claim re-pointed
Claims processor
CLM-426717 → UHC-34141-14 (Theresa Chavez)
Member id
UHC-34141-14
Confidence
0.97
Method
deterministic
MBR-012449CLM-426717
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008420
Orphan claim re-pointed
Claims processor
CLM-404443 → UHC-76520-73 (Sandra Kim)
Member id
UHC-76520-73
Confidence
0.97
Method
deterministic
MBR-000585CLM-404443
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008421
Orphan claim re-pointed
Claims processor
CLM-422574 → UHC-04297-64 (Samantha Reid)
Member id
UHC-04297-64
Confidence
1
Method
probabilistic
MBR-006491CLM-422574
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008422
Orphan claim re-pointed
Claims processor
CLM-414611 → UHC-55711-88 (Kathy Garrett)
Member id
UHC-55711-88
Confidence
0.97
Method
deterministic
MBR-023059CLM-414611
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008423
Orphan claim re-pointed
Claims processor
CLM-424559 → UHC-04038-37 (Kimberly Austin)
Member id
UHC-04038-37
Confidence
1
Method
probabilistic
MBR-002279CLM-424559
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008424
Orphan claim re-pointed
Claims processor
CLM-419268 → UHC-53669-74 (Bradley Powell)
Member id
UHC-53669-74
Confidence
0.94
Method
probabilistic
MBR-015857CLM-419268
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008425
Orphan claim re-pointed
Claims processor
CLM-417790 → UHC-80007-46 (Wayne Simpson)
Member id
UHC-80007-46
Confidence
1
Method
probabilistic
MBR-008791CLM-417790
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008426
Orphan claim re-pointed
Claims processor
CLM-420572 → UHC-12915-66 (Austin Matthews)
Member id
UHC-12915-66
Confidence
1
Method
probabilistic
MBR-007937CLM-420572
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008427
Orphan claim re-pointed
Claims processor
CLM-429567 → UHC-43400-99 (Alexis Armstrong)
Member id
UHC-43400-99
Confidence
1
Method
probabilistic
MBR-000445CLM-429567
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008428
Orphan claim re-pointed
Claims processor
CLM-431955 → UHC-19650-15 (Bevery Lane)
Member id
UHC-19650-15
Confidence
0.99
Method
probabilistic
MBR-008566CLM-431955
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008429
Orphan claim re-pointed
Claims processor
CLM-431247 → UHC-13315-65 (Gregory Dean)
Member id
UHC-13315-65
Confidence
1
Method
probabilistic
MBR-006813CLM-431247
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008430
Orphan claim re-pointed
Claims processor
CLM-432651 → UHC-35610-05 (Ommar Brown)
Member id
UHC-35610-05
Confidence
0.99
Method
probabilistic
MBR-036511CLM-432651
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008431
Orphan claim re-pointed
Claims processor
CLM-423427 → UHC-26304-24 (Ralph Knight)
Member id
UHC-26304-24
Confidence
1
Method
probabilistic
MBR-005177CLM-423427
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008432
Orphan claim re-pointed
Claims processor
CLM-409165 → UHC-80089-58 (Juan Murphy)
Member id
UHC-80089-58
Confidence
1
Method
probabilistic
MBR-016812CLM-409165
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008433
Orphan claim re-pointed
Claims processor
CLM-427974 → UHC-05006-39 (Christopher Obrien)
Member id
UHC-05006-39
Confidence
0.99
Method
probabilistic
MBR-019906CLM-427974
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008434
Orphan claim re-pointed
Claims processor
CLM-407763 → UHC-02209-49 (Heather Hansen)
Member id
UHC-02209-49
Confidence
0.97
Method
deterministic
MBR-030647CLM-407763
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008435
Orphan claim re-pointed
Claims processor
CLM-417523 → UHC-33844-49 (Michelle Green)
Member id
UHC-33844-49
Confidence
1
Method
probabilistic
MBR-035846CLM-417523
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008436
Orphan claim re-pointed
Claims processor
CLM-419627 → UHC-32260-32 (Timothy Perry)
Member id
UHC-32260-32
Confidence
1
Method
probabilistic
MBR-020133CLM-419627
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008437
Orphan claim re-pointed
Claims processor
CLM-411561 → UHC-15893-43 (Hannah Andrews)
Member id
UHC-15893-43
Confidence
0.93
Method
probabilistic
MBR-043515CLM-411561
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008438
Orphan claim re-pointed
Claims processor
CLM-406776 → UHC-24250-02 (Carl Owens)
Member id
UHC-24250-02
Confidence
1
Method
probabilistic
MBR-006677CLM-406776
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008439
Orphan claim re-pointed
Claims processor
CLM-403519 → UHC-13349-08 (Pamela Thompson)
Member id
UHC-13349-08
Confidence
0.90
Method
probabilistic
MBR-019841CLM-403519
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 142 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.