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-009240
Orphan claim re-pointed
Claims processor
CLM-421741 → UHC-22202-45 (Ntaalie Ward)
Member id
UHC-22202-45
Confidence
0.99
Method
probabilistic
MBR-000944CLM-421741
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009241
Orphan claim re-pointed
Claims processor
CLM-429085 → UHC-50742-28 (Thomas Snyder)
Member id
UHC-50742-28
Confidence
0.97
Method
deterministic
MBR-000368CLM-429085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009242
Orphan claim re-pointed
Claims processor
CLM-415094 → UHC-88221-68 (Abigail Berry)
Member id
UHC-88221-68
Confidence
1
Method
probabilistic
MBR-027257CLM-415094
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009243
Orphan claim re-pointed
Claims processor
CLM-420016 → UHC-07607-29 (Mark Lopez)
Member id
UHC-07607-29
Confidence
1
Method
probabilistic
MBR-031312CLM-420016
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009244
Orphan claim re-pointed
Claims processor
CLM-413668 → UHC-79675-66 (Stephen Bailey)
Member id
UHC-79675-66
Confidence
1
Method
probabilistic
MBR-042733CLM-413668
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009245
Orphan claim re-pointed
Claims processor
CLM-413128 → UHC-32395-41 (Randy Campbell)
Member id
UHC-32395-41
Confidence
0.97
Method
deterministic
MBR-000176CLM-413128
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009246
Orphan claim re-pointed
Claims processor
CLM-432423 → UHC-69967-07 (Kayla Roberts)
Member id
UHC-69967-07
Confidence
1
Method
probabilistic
MBR-012360CLM-432423
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009247
Orphan claim re-pointed
Claims processor
CLM-424997 → UHC-37104-79 (Ralph Wright)
Member id
UHC-37104-79
Confidence
0.97
Method
deterministic
MBR-023687CLM-424997
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009248
Orphan claim re-pointed
Claims processor
CLM-425796 → UHC-12027-17 (Debra Spencer)
Member id
UHC-12027-17
Confidence
1
Method
probabilistic
MBR-001115CLM-425796
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009249
Orphan claim re-pointed
Claims processor
CLM-407391 → UHC-07589-19 (Dylan Stone)
Member id
UHC-07589-19
Confidence
0.93
Method
probabilistic
MBR-014086CLM-407391
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009250
Orphan claim re-pointed
Claims processor
CLM-418733 → UHC-67061-31 (Lauren Martinez)
Member id
UHC-67061-31
Confidence
1
Method
probabilistic
MBR-000698CLM-418733
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009251
Orphan claim re-pointed
Claims processor
CLM-405916 → UHC-82374-33 (Beverly Burns)
Member id
UHC-82374-33
Confidence
0.97
Method
deterministic
MBR-025340CLM-405916
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009252
Orphan claim re-pointed
Claims processor
CLM-412731 → UHC-50637-70 (Maria Espinoza)
Member id
UHC-50637-70
Confidence
0.97
Method
deterministic
MBR-027450CLM-412731
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009253
Orphan claim re-pointed
Claims processor
CLM-400948 → UHC-55811-29 (Heather Lopez)
Member id
UHC-55811-29
Confidence
1
Method
probabilistic
MBR-033403CLM-400948
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009254
Orphan claim re-pointed
Claims processor
CLM-421942 → UHC-12863-64 (Ryan Nunez)
Member id
UHC-12863-64
Confidence
1
Method
probabilistic
MBR-022490CLM-421942
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009255
Orphan claim re-pointed
Claims processor
CLM-432312 → UHC-35129-23 (Ashley Silva)
Member id
UHC-35129-23
Confidence
1
Method
probabilistic
MBR-033944CLM-432312
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009256
Orphan claim re-pointed
Claims processor
CLM-431388 → UHC-15907-37 (Wayne Howard)
Member id
UHC-15907-37
Confidence
1
Method
probabilistic
MBR-018406CLM-431388
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009257
Orphan claim re-pointed
Claims processor
CLM-408017 → UHC-66895-93 (Beverly Rios)
Member id
UHC-66895-93
Confidence
1
Method
probabilistic
MBR-016872CLM-408017
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009258
Orphan claim re-pointed
Claims processor
CLM-430230 → UHC-73684-45 (Maria Montgomery)
Member id
UHC-73684-45
Confidence
1
Method
probabilistic
MBR-007590CLM-430230
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009259
Orphan claim re-pointed
Claims processor
CLM-403469 → UHC-86169-56 (Anthony Bryant)
Member id
UHC-86169-56
Confidence
1
Method
probabilistic
MBR-033043CLM-403469
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009260
Orphan claim re-pointed
Claims processor
CLM-402354 → UHC-24589-90 (Angela Williams)
Member id
UHC-24589-90
Confidence
0.93
Method
probabilistic
MBR-004088CLM-402354
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009261
Orphan claim re-pointed
Claims processor
CLM-405125 → UHC-37873-37 (Carol Fisher)
Member id
UHC-37873-37
Confidence
1
Method
probabilistic
MBR-011648CLM-405125
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009262
Orphan claim re-pointed
Claims processor
CLM-417015 → UHC-08324-56 (Alice Soto)
Member id
UHC-08324-56
Confidence
1
Method
probabilistic
MBR-026940CLM-417015
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009263
Orphan claim re-pointed
Claims processor
CLM-424894 → UHC-23833-14 (Frank Roberts)
Member id
UHC-23833-14
Confidence
1
Method
probabilistic
MBR-017735CLM-424894
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009264
Orphan claim re-pointed
Claims processor
CLM-411591 → UHC-44229-83 (Lawrence Mejia)
Member id
UHC-44229-83
Confidence
1
Method
probabilistic
MBR-002665CLM-411591
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009265
Orphan claim re-pointed
Claims processor
CLM-428918 → UHC-62188-44 (Donald Cooper)
Member id
UHC-62188-44
Confidence
1
Method
probabilistic
MBR-019346CLM-428918
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009266
Orphan claim re-pointed
Claims processor
CLM-425389 → UHC-87363-59 (Peter Walsh)
Member id
UHC-87363-59
Confidence
1
Method
probabilistic
MBR-024404CLM-425389
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009267
Orphan claim re-pointed
Claims processor
CLM-411963 → UHC-08621-59 (Isabella Chavez)
Member id
UHC-08621-59
Confidence
1
Method
probabilistic
MBR-002394CLM-411963
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009268
Orphan claim re-pointed
Claims processor
CLM-400560 → UHC-22304-73 (Mateo Espinoza)
Member id
UHC-22304-73
Confidence
0.97
Method
deterministic
MBR-001091CLM-400560
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009269
Orphan claim re-pointed
Claims processor
CLM-423840 → UHC-65429-19 (Noah Ortiz)
Member id
UHC-65429-19
Confidence
1
Method
probabilistic
MBR-020343CLM-423840
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009270
Orphan claim re-pointed
Claims processor
CLM-429510 → UHC-70785-96 (Natalie Freeman)
Member id
UHC-70785-96
Confidence
0.97
Method
deterministic
MBR-000355CLM-429510
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009271
Orphan claim re-pointed
Claims processor
CLM-429874 → UHC-65196-52 (Lauren Sullivan)
Member id
UHC-65196-52
Confidence
1
Method
probabilistic
MBR-014799CLM-429874
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009272
Orphan claim re-pointed
Claims processor
CLM-426750 → UHC-02311-67 (Bradley Bishop)
Member id
UHC-02311-67
Confidence
0.97
Method
deterministic
MBR-014437CLM-426750
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009273
Orphan claim re-pointed
Claims processor
CLM-422111 → UHC-09967-78 (Emily Bennett)
Member id
UHC-09967-78
Confidence
0.99
Method
probabilistic
MBR-010313CLM-422111
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009274
Orphan claim re-pointed
Claims processor
CLM-402018 → UHC-43714-69 (Dylan Webb)
Member id
UHC-43714-69
Confidence
0.99
Method
probabilistic
MBR-039308CLM-402018
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009275
Orphan claim re-pointed
Claims processor
CLM-428072 → UHC-98453-76 (Janice Hamilton)
Member id
UHC-98453-76
Confidence
1
Method
probabilistic
MBR-033953CLM-428072
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009276
Orphan claim re-pointed
Claims processor
CLM-432291 → UHC-70601-68 (Amber Ruiz)
Member id
UHC-70601-68
Confidence
1
Method
probabilistic
MBR-027381CLM-432291
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009277
Orphan claim re-pointed
Claims processor
CLM-410522 → UHC-44470-52 (Lucia Watson)
Member id
UHC-44470-52
Confidence
1
Method
probabilistic
MBR-028951CLM-410522
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009278
Orphan claim re-pointed
Claims processor
CLM-400531 → UHC-90545-25 (Helen Singh)
Member id
UHC-90545-25
Confidence
0.99
Method
probabilistic
MBR-008075CLM-400531
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009279
Orphan claim re-pointed
Claims processor
CLM-414197 → UHC-01209-57 (Kathryn Ortiz)
Member id
UHC-01209-57
Confidence
0.97
Method
deterministic
MBR-010213CLM-414197
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009280
Orphan claim re-pointed
Claims processor
CLM-407032 → UHC-15519-28 (Joyce Santos)
Member id
UHC-15519-28
Confidence
1
Method
probabilistic
MBR-012783CLM-407032
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009281
Orphan claim re-pointed
Claims processor
CLM-408467 → UHC-70825-08 (Judy Payne)
Member id
UHC-70825-08
Confidence
1
Method
probabilistic
MBR-008585CLM-408467
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009282
Orphan claim re-pointed
Claims processor
CLM-404697 → UHC-76713-41 (Brenda Stephens)
Member id
UHC-76713-41
Confidence
1
Method
probabilistic
MBR-004014CLM-404697
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009283
Orphan claim re-pointed
Claims processor
CLM-414441 → UHC-64017-72 (Evelyn Guzman)
Member id
UHC-64017-72
Confidence
1
Method
probabilistic
MBR-005772CLM-414441
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009284
Orphan claim re-pointed
Claims processor
CLM-407410 → UHC-40634-02 (Cynthia Nguyen)
Member id
UHC-40634-02
Confidence
0.97
Method
deterministic
MBR-003601CLM-407410
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009285
Orphan claim re-pointed
Claims processor
CLM-428980 → UHC-00004-76 (Carol Bryant)
Member id
UHC-00004-76
Confidence
1
Method
probabilistic
MBR-003055CLM-428980
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009286
Orphan claim re-pointed
Claims processor
CLM-405124 → UHC-29366-06 (Jerry Andrews)
Member id
UHC-29366-06
Confidence
1
Method
probabilistic
MBR-006314CLM-405124
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009287
Orphan claim re-pointed
Claims processor
CLM-421081 → UHC-68316-58 (Robert Guerrero)
Member id
UHC-68316-58
Confidence
0.97
Method
deterministic
MBR-023389CLM-421081
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009288
Orphan claim re-pointed
Claims processor
CLM-404846 → UHC-96702-58 (Julie Franklin)
Member id
UHC-96702-58
Confidence
0.97
Method
deterministic
MBR-000633CLM-404846
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009289
Orphan claim re-pointed
Claims processor
CLM-409709 → UHC-56324-15 (Donna Coleman)
Member id
UHC-56324-15
Confidence
0.97
Method
deterministic
MBR-015119CLM-409709
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 159 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.