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-009640
Orphan claim re-pointed
Claims processor
CLM-402903 → UHC-84406-53 (Alexander Contreras)
Member id
UHC-84406-53
Confidence
1
Method
probabilistic
MBR-002419CLM-402903
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009641
Orphan claim re-pointed
Claims processor
CLM-427056 → UHC-73279-07 (Santiago Collins)
Member id
UHC-73279-07
Confidence
0.97
Method
deterministic
MBR-032146CLM-427056
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009642
Orphan claim re-pointed
Claims processor
CLM-406250 → UHC-02773-73 (Martha Rodriguez)
Member id
UHC-02773-73
Confidence
0.97
Method
deterministic
MBR-000708CLM-406250
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009643
Orphan claim re-pointed
Claims processor
CLM-405350 → UHC-50320-21 (Ana Bailey)
Member id
UHC-50320-21
Confidence
0.97
Method
deterministic
MBR-014435CLM-405350
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009644
Orphan claim re-pointed
Claims processor
CLM-425888 → UHC-90277-38 (Randy Edwards)
Member id
UHC-90277-38
Confidence
1
Method
probabilistic
MBR-013522CLM-425888
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009645
Orphan claim re-pointed
Claims processor
CLM-417736 → UHC-05335-91 (Wayne Castro)
Member id
UHC-05335-91
Confidence
0.97
Method
deterministic
MBR-009948CLM-417736
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009646
Orphan claim re-pointed
Claims processor
CLM-427729 → UHC-06478-92 (Alexander Smith)
Member id
UHC-06478-92
Confidence
0.99
Method
probabilistic
MBR-024489CLM-427729
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009647
Orphan claim re-pointed
Claims processor
CLM-418747 → UHC-00279-10 (Brittany Lucas)
Member id
UHC-00279-10
Confidence
0.98
Method
probabilistic
MBR-017816CLM-418747
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009648
Orphan claim re-pointed
Claims processor
CLM-406437 → UHC-33550-60 (Wei Nelson)
Member id
UHC-33550-60
Confidence
1
Method
probabilistic
MBR-020362CLM-406437
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009649
Orphan claim re-pointed
Claims processor
CLM-406880 → UHC-12515-95 (Ana Gibson)
Member id
UHC-12515-95
Confidence
1
Method
probabilistic
MBR-009099CLM-406880
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009650
Orphan claim re-pointed
Claims processor
CLM-417082 → UHC-29227-75 (Carolyn Sanchez)
Member id
UHC-29227-75
Confidence
1
Method
probabilistic
MBR-007385CLM-417082
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009651
Orphan claim re-pointed
Claims processor
CLM-407467 → UHC-13189-31 (Vincent Adams)
Member id
UHC-13189-31
Confidence
1
Method
probabilistic
MBR-035000CLM-407467
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009652
Orphan claim re-pointed
Claims processor
CLM-428481 → UHC-75505-45 (Keith Graham)
Member id
UHC-75505-45
Confidence
0.97
Method
deterministic
MBR-004957CLM-428481
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009653
Orphan claim re-pointed
Claims processor
CLM-422330 → UHC-52550-77 (Charles Cook)
Member id
UHC-52550-77
Confidence
0.97
Method
deterministic
MBR-015086CLM-422330
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009654
Orphan claim re-pointed
Claims processor
CLM-406382 → UHC-91130-49 (Vincent Jenkins)
Member id
UHC-91130-49
Confidence
1
Method
probabilistic
MBR-028379CLM-406382
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009655
Orphan claim re-pointed
Claims processor
CLM-403085 → UHC-61741-31 (Charlotte Rogers)
Member id
UHC-61741-31
Confidence
1
Method
probabilistic
MBR-015116CLM-403085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009656
Orphan claim re-pointed
Claims processor
CLM-420523 → UHC-80996-85 (Denise Ramos)
Member id
UHC-80996-85
Confidence
1
Method
probabilistic
MBR-003840CLM-420523
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009657
Orphan claim re-pointed
Claims processor
CLM-420771 → UHC-57626-40 (Jonathan Marquez)
Member id
UHC-57626-40
Confidence
0.97
Method
deterministic
MBR-043712CLM-420771
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009658
Orphan claim re-pointed
Claims processor
CLM-405783 → UHC-59682-46 (Doris Robertson)
Member id
UHC-59682-46
Confidence
1
Method
probabilistic
MBR-006165CLM-405783
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009659
Orphan claim re-pointed
Claims processor
CLM-431960 → UHC-03242-36 (Ralph Andrews)
Member id
UHC-03242-36
Confidence
1
Method
probabilistic
MBR-007960CLM-431960
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009660
Orphan claim re-pointed
Claims processor
CLM-428694 → UHC-92720-51 (Lucia Rios)
Member id
UHC-92720-51
Confidence
1
Method
probabilistic
MBR-006680CLM-428694
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009661
Orphan claim re-pointed
Claims processor
CLM-429793 → UHC-26263-45 (Jeremy Moore)
Member id
UHC-26263-45
Confidence
1
Method
probabilistic
MBR-000239CLM-429793
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009662
Orphan claim re-pointed
Claims processor
CLM-432088 → UHC-15097-94 (Bruce Collins)
Member id
UHC-15097-94
Confidence
1
Method
probabilistic
MBR-023076CLM-432088
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009663
Orphan claim re-pointed
Claims processor
CLM-432092 → UHC-20902-13 (Samantha Fuller)
Member id
UHC-20902-13
Confidence
1
Method
probabilistic
MBR-011008CLM-432092
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009664
Orphan claim re-pointed
Claims processor
CLM-413788 → UHC-01066-48 (Alice Baker)
Member id
UHC-01066-48
Confidence
1
Method
probabilistic
MBR-002944CLM-413788
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009665
Orphan claim re-pointed
Claims processor
CLM-417620 → UHC-21667-70 (Logan Daniels)
Member id
UHC-21667-70
Confidence
1
Method
probabilistic
MBR-041318CLM-417620
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009666
Orphan claim re-pointed
Claims processor
CLM-411132 → UHC-39221-56 (Lori Garcia)
Member id
UHC-39221-56
Confidence
1
Method
probabilistic
MBR-012451CLM-411132
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009667
Orphan claim re-pointed
Claims processor
CLM-429543 → UHC-90001-13 (Omar Boyd)
Member id
UHC-90001-13
Confidence
1
Method
probabilistic
MBR-027759CLM-429543
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009668
Orphan claim re-pointed
Claims processor
CLM-413003 → UHC-54709-71 (Mateo Barnes)
Member id
UHC-54709-71
Confidence
0.97
Method
deterministic
MBR-012219CLM-413003
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009669
Orphan claim re-pointed
Claims processor
CLM-405133 → UHC-08142-79 (Richard Silva)
Member id
UHC-08142-79
Confidence
1.00
Method
probabilistic
MBR-011684CLM-405133
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009670
Orphan claim re-pointed
Claims processor
CLM-406631 → UHC-27982-32 (Lori Lane)
Member id
UHC-27982-32
Confidence
1
Method
probabilistic
MBR-010158CLM-406631
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009671
Orphan claim re-pointed
Claims processor
CLM-424887 → UHC-92295-16 (Joyce Hunter)
Member id
UHC-92295-16
Confidence
1
Method
probabilistic
MBR-013433CLM-424887
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009672
Orphan claim re-pointed
Claims processor
CLM-419046 → UHC-44964-27 (Peter Parker)
Member id
UHC-44964-27
Confidence
0.97
Method
deterministic
MBR-039414CLM-419046
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009673
Orphan claim re-pointed
Claims processor
CLM-422180 → UHC-18366-77 (Evelyn Graham)
Member id
UHC-18366-77
Confidence
0.93
Method
probabilistic
MBR-005585CLM-422180
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009674
Orphan claim re-pointed
Claims processor
CLM-429609 → UHC-30744-33 (Elizabeth Stone)
Member id
UHC-30744-33
Confidence
1
Method
probabilistic
MBR-036167CLM-429609
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009675
Orphan claim re-pointed
Claims processor
CLM-416896 → UHC-68238-77 (Carol Hall)
Member id
UHC-68238-77
Confidence
0.99
Method
probabilistic
MBR-011289CLM-416896
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009676
Orphan claim re-pointed
Claims processor
CLM-403901 → UHC-83339-71 (Sofia Greene)
Member id
UHC-83339-71
Confidence
1
Method
probabilistic
MBR-000537CLM-403901
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009677
Orphan claim re-pointed
Claims processor
CLM-413551 → UHC-46841-03 (Rachel Richardson)
Member id
UHC-46841-03
Confidence
1
Method
probabilistic
MBR-020287CLM-413551
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009678
Orphan claim re-pointed
Claims processor
CLM-406707 → UHC-78584-61 (Adams Frank)
Member id
UHC-78584-61
Confidence
0.98
Method
probabilistic
MBR-042039CLM-406707
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009679
Orphan claim re-pointed
Claims processor
CLM-427703 → UHC-85622-08 (Jacqueline Mitchell)
Member id
UHC-85622-08
Confidence
1
Method
probabilistic
MBR-016059CLM-427703
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009680
Orphan claim re-pointed
Claims processor
CLM-420076 → UHC-29692-11 (Laura Cooper)
Member id
UHC-29692-11
Confidence
1
Method
probabilistic
MBR-012501CLM-420076
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009681
Orphan claim re-pointed
Claims processor
CLM-424208 → UHC-53662-77 (Linda Wong)
Member id
UHC-53662-77
Confidence
1
Method
probabilistic
MBR-013676CLM-424208
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009682
Orphan claim re-pointed
Claims processor
CLM-432802 → UHC-67388-37 (Eugene Graham)
Member id
UHC-67388-37
Confidence
1
Method
probabilistic
MBR-031449CLM-432802
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009683
Orphan claim re-pointed
Claims processor
CLM-421463 → UHC-66715-60 (Denise Arnold)
Member id
UHC-66715-60
Confidence
1
Method
probabilistic
MBR-025291CLM-421463
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009684
Orphan claim re-pointed
Claims processor
CLM-422229 → UHC-14730-39 (Gerald Hicks)
Member id
UHC-14730-39
Confidence
0.99
Method
probabilistic
MBR-017162CLM-422229
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009685
Orphan claim re-pointed
Claims processor
CLM-412878 → UHC-62480-15 (Barbara Vazquez)
Member id
UHC-62480-15
Confidence
0.97
Method
deterministic
MBR-042201CLM-412878
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009686
Orphan claim re-pointed
Claims processor
CLM-412152 → UHC-61614-87 (Sandra Estrada)
Member id
UHC-61614-87
Confidence
1
Method
probabilistic
MBR-013386CLM-412152
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009687
Orphan claim re-pointed
Claims processor
CLM-404299 → UHC-66632-26 (Randy Snyder)
Member id
UHC-66632-26
Confidence
1
Method
probabilistic
MBR-038978CLM-404299
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009688
Orphan claim re-pointed
Claims processor
CLM-415507 → UHC-27166-87 (Cheryl Hoffman)
Member id
UHC-27166-87
Confidence
1
Method
probabilistic
MBR-018641CLM-415507
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009689
Orphan claim re-pointed
Claims processor
CLM-406044 → UHC-05239-58 (Nicole Sullivan)
Member id
UHC-05239-58
Confidence
1
Method
probabilistic
MBR-029680CLM-406044
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 167 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.