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-009190
Orphan claim re-pointed
Claims processor
CLM-428707 → UHC-38582-59 (Charlotte Alexander)
Member id
UHC-38582-59
Confidence
0.98
Method
probabilistic
MBR-017145CLM-428707
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009191
Orphan claim re-pointed
Claims processor
CLM-400272 → UHC-25022-82 (Kenneth Reynolds)
Member id
UHC-25022-82
Confidence
0.97
Method
deterministic
MBR-006118CLM-400272
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009192
Orphan claim re-pointed
Claims processor
CLM-403911 → UHC-70525-73 (Donna Griffin)
Member id
UHC-70525-73
Confidence
0.97
Method
deterministic
MBR-035486CLM-403911
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009193
Orphan claim re-pointed
Claims processor
CLM-411674 → UHC-39682-17 (Grace Guzman)
Member id
UHC-39682-17
Confidence
0.99
Method
probabilistic
MBR-020211CLM-411674
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009194
Orphan claim re-pointed
Claims processor
CLM-427565 → UHC-11526-69 (Brian Patel)
Member id
UHC-11526-69
Confidence
1
Method
probabilistic
MBR-027158CLM-427565
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009195
Orphan claim re-pointed
Claims processor
CLM-424753 → UHC-13868-34 (Harold Rios)
Member id
UHC-13868-34
Confidence
1
Method
probabilistic
MBR-014264CLM-424753
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009196
Orphan claim re-pointed
Claims processor
CLM-428297 → UHC-99707-65 (Michael Carpenter)
Member id
UHC-99707-65
Confidence
0.99
Method
probabilistic
MBR-009991CLM-428297
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009197
Orphan claim re-pointed
Claims processor
CLM-417227 → UHC-45726-10 (Jordan Vasquez)
Member id
UHC-45726-10
Confidence
0.97
Method
deterministic
MBR-002930CLM-417227
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009198
Orphan claim re-pointed
Claims processor
CLM-417011 → UHC-16577-28 (Justin Jackson)
Member id
UHC-16577-28
Confidence
0.94
Method
probabilistic
MBR-020592CLM-417011
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009199
Orphan claim re-pointed
Claims processor
CLM-401341 → UHC-05992-19 (Catherine Ellis)
Member id
UHC-05992-19
Confidence
1
Method
probabilistic
MBR-012410CLM-401341
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009200
Orphan claim re-pointed
Claims processor
CLM-409823 → UHC-93802-82 (Frances Graham)
Member id
UHC-93802-82
Confidence
1
Method
probabilistic
MBR-033925CLM-409823
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009201
Orphan claim re-pointed
Claims processor
CLM-427074 → UHC-77787-12 (Deborah Obrien)
Member id
UHC-77787-12
Confidence
1
Method
probabilistic
MBR-002791CLM-427074
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009202
Orphan claim re-pointed
Claims processor
CLM-432337 → UHC-80730-48 (Richard Hall)
Member id
UHC-80730-48
Confidence
0.97
Method
deterministic
MBR-004294CLM-432337
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009203
Orphan claim re-pointed
Claims processor
CLM-430458 → UHC-50436-75 (Benjamin Ferguson)
Member id
UHC-50436-75
Confidence
1
Method
probabilistic
MBR-025667CLM-430458
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009204
Orphan claim re-pointed
Claims processor
CLM-424711 → UHC-07807-62 (Dylan Parker)
Member id
UHC-07807-62
Confidence
0.99
Method
probabilistic
MBR-028448CLM-424711
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009205
Orphan claim re-pointed
Claims processor
CLM-421577 → UHC-75772-33 (Michael Hanson)
Member id
UHC-75772-33
Confidence
0.99
Method
probabilistic
MBR-015366CLM-421577
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009206
Orphan claim re-pointed
Claims processor
CLM-404505 → UHC-39290-43 (Juan Morrison)
Member id
UHC-39290-43
Confidence
0.97
Method
deterministic
MBR-025219CLM-404505
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009207
Orphan claim re-pointed
Claims processor
CLM-403337 → UHC-80513-60 (Liz Robinson)
Member id
UHC-80513-60
Confidence
0.97
Method
deterministic
MBR-035134CLM-403337
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009208
Orphan claim re-pointed
Claims processor
CLM-415745 → UHC-82208-74 (Nancy Myers)
Member id
UHC-82208-74
Confidence
1
Method
probabilistic
MBR-004015CLM-415745
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009209
Orphan claim re-pointed
Claims processor
CLM-428647 → UHC-42607-41 (Kathy Palmer)
Member id
UHC-42607-41
Confidence
0.97
Method
deterministic
MBR-038125CLM-428647
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009210
Orphan claim re-pointed
Claims processor
CLM-406445 → UHC-43328-08 (Abby Vazquez)
Member id
UHC-43328-08
Confidence
1
Method
probabilistic
MBR-011460CLM-406445
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009211
Orphan claim re-pointed
Claims processor
CLM-408801 → UHC-04306-87 (Theresa Wheeler)
Member id
UHC-04306-87
Confidence
1
Method
probabilistic
MBR-004918CLM-408801
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009212
Orphan claim re-pointed
Claims processor
CLM-419850 → UHC-79133-62 (Eric McDonald)
Member id
UHC-79133-62
Confidence
0.99
Method
probabilistic
MBR-020521CLM-419850
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009213
Orphan claim re-pointed
Claims processor
CLM-420828 → UHC-87262-31 (Paul Butler)
Member id
UHC-87262-31
Confidence
0.97
Method
deterministic
MBR-000745CLM-420828
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009214
Orphan claim re-pointed
Claims processor
CLM-424873 → UHC-21910-53 (Alice Porter)
Member id
UHC-21910-53
Confidence
1
Method
probabilistic
MBR-008822CLM-424873
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009215
Orphan claim re-pointed
Claims processor
CLM-426958 → UHC-18445-56 (Joan Sanders)
Member id
UHC-18445-56
Confidence
0.94
Method
probabilistic
MBR-023484CLM-426958
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009216
Orphan claim re-pointed
Claims processor
CLM-418789 → UHC-75126-91 (Bryan Morris)
Member id
UHC-75126-91
Confidence
1
Method
probabilistic
MBR-018694CLM-418789
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009217
Orphan claim re-pointed
Claims processor
CLM-413822 → UHC-28890-43 (Madison Jenkins)
Member id
UHC-28890-43
Confidence
1
Method
probabilistic
MBR-040823CLM-413822
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009218
Orphan claim re-pointed
Claims processor
CLM-413715 → UHC-92115-37 (Denise Hayes)
Member id
UHC-92115-37
Confidence
0.99
Method
probabilistic
MBR-031286CLM-413715
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009219
Orphan claim re-pointed
Claims processor
CLM-408773 → UHC-76784-79 (Joyce Gibson)
Member id
UHC-76784-79
Confidence
1
Method
probabilistic
MBR-015264CLM-408773
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009220
Orphan claim re-pointed
Claims processor
CLM-427634 → UHC-19542-78 (Justin Barnes)
Member id
UHC-19542-78
Confidence
1
Method
probabilistic
MBR-018913CLM-427634
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009221
Orphan claim re-pointed
Claims processor
CLM-401348 → UHC-92157-55 (Justin Rodriguez)
Member id
UHC-92157-55
Confidence
0.88
Method
probabilistic
MBR-002632CLM-401348
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009222
Orphan claim re-pointed
Claims processor
CLM-417667 → UHC-39147-21 (Samantha Diaz)
Member id
UHC-39147-21
Confidence
1
Method
probabilistic
MBR-009858CLM-417667
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009223
Orphan claim re-pointed
Claims processor
CLM-422753 → UHC-93830-13 (Julie Weaver)
Member id
UHC-93830-13
Confidence
1
Method
probabilistic
MBR-007705CLM-422753
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009224
Orphan claim re-pointed
Claims processor
CLM-423712 → UHC-37491-91 (Ashley Marshall)
Member id
UHC-37491-91
Confidence
1
Method
probabilistic
MBR-012896CLM-423712
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009225
Orphan claim re-pointed
Claims processor
CLM-407189 → UHC-52970-96 (Linda Obrien)
Member id
UHC-52970-96
Confidence
1
Method
probabilistic
MBR-033382CLM-407189
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009226
Orphan claim re-pointed
Claims processor
CLM-407762 → UHC-37982-54 (Priya Price)
Member id
UHC-37982-54
Confidence
1
Method
probabilistic
MBR-017974CLM-407762
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009227
Orphan claim re-pointed
Claims processor
CLM-419801 → UHC-19446-14 (Diane Reid)
Member id
UHC-19446-14
Confidence
1
Method
probabilistic
MBR-010405CLM-419801
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009228
Orphan claim re-pointed
Claims processor
CLM-400016 → UHC-39574-66 (Margaret Bell)
Member id
UHC-39574-66
Confidence
1.00
Method
probabilistic
MBR-002342CLM-400016
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009229
Orphan claim re-pointed
Claims processor
CLM-403552 → UHC-39760-46 (Carolyn Jackson)
Member id
UHC-39760-46
Confidence
1
Method
probabilistic
MBR-012381CLM-403552
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009230
Orphan claim re-pointed
Claims processor
CLM-406527 → UHC-97135-95 (Charlotte Edwards)
Member id
UHC-97135-95
Confidence
0.97
Method
deterministic
MBR-003906CLM-406527
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009231
Orphan claim re-pointed
Claims processor
CLM-432099 → UHC-21397-33 (Rachel Vazuez)
Member id
UHC-21397-33
Confidence
0.97
Method
deterministic
MBR-022160CLM-432099
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009232
Orphan claim re-pointed
Claims processor
CLM-406604 → UHC-65800-71 (Ray Garza)
Member id
UHC-65800-71
Confidence
1
Method
probabilistic
MBR-006684CLM-406604
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009233
Orphan claim re-pointed
Claims processor
CLM-428807 → UHC-98736-64 (Douglas Stewart)
Member id
UHC-98736-64
Confidence
1
Method
probabilistic
MBR-005087CLM-428807
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009234
Orphan claim re-pointed
Claims processor
CLM-401222 → UHC-28284-55 (Julie Romero)
Member id
UHC-28284-55
Confidence
1
Method
probabilistic
MBR-025898CLM-401222
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009235
Orphan claim re-pointed
Claims processor
CLM-410407 → UHC-33225-10 (Chris James)
Member id
UHC-33225-10
Confidence
1
Method
probabilistic
MBR-023299CLM-410407
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009236
Orphan claim re-pointed
Claims processor
CLM-425091 → UHC-38982-72 (Grace Dominguez)
Member id
UHC-38982-72
Confidence
1
Method
probabilistic
MBR-004889CLM-425091
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009237
Orphan claim re-pointed
Claims processor
CLM-424011 → UHC-97185-04 (Marcus Ramirez)
Member id
UHC-97185-04
Confidence
1
Method
probabilistic
MBR-029734CLM-424011
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009238
Orphan claim re-pointed
Claims processor
CLM-402839 → UHC-18090-11 (Janet Harvey)
Member id
UHC-18090-11
Confidence
1
Method
probabilistic
MBR-001341CLM-402839
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009239
Orphan claim re-pointed
Claims processor
CLM-414462 → UHC-55392-40 (Linda Davis)
Member id
UHC-55392-40
Confidence
1
Method
probabilistic
MBR-001946CLM-414462
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 158 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.