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-009840
Orphan claim re-pointed
Claims processor
CLM-415192 → UHC-25116-10 (Arthur Morgan)
Member id
UHC-25116-10
Confidence
1
Method
probabilistic
MBR-024713CLM-415192
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009841
Orphan claim re-pointed
Claims processor
CLM-406016 → UHC-32609-65 (Deborah Riley)
Member id
UHC-32609-65
Confidence
1
Method
probabilistic
MBR-004683CLM-406016
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009842
Orphan claim re-pointed
Claims processor
CLM-426645 → UHC-22256-78 (Teresa Park)
Member id
UHC-22256-78
Confidence
0.97
Method
deterministic
MBR-012835CLM-426645
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009843
Orphan claim re-pointed
Claims processor
CLM-409466 → UHC-82176-57 (Wayne Diez)
Member id
UHC-82176-57
Confidence
0.98
Method
probabilistic
MBR-029394CLM-409466
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009844
Orphan claim re-pointed
Claims processor
CLM-424471 → UHC-86329-56 (Gerald Olson)
Member id
UHC-86329-56
Confidence
1
Method
probabilistic
MBR-007438CLM-424471
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009845
Orphan claim re-pointed
Claims processor
CLM-410891 → UHC-91757-89 (Katherine Bell)
Member id
UHC-91757-89
Confidence
1
Method
probabilistic
MBR-026521CLM-410891
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009846
Orphan claim re-pointed
Claims processor
CLM-414948 → UHC-68184-37 (Randy Singh)
Member id
UHC-68184-37
Confidence
0.86
Method
probabilistic
MBR-029466CLM-414948
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009847
Orphan claim re-pointed
Claims processor
CLM-429457 → UHC-11839-77 (Harold Barnes)
Member id
UHC-11839-77
Confidence
0.94
Method
probabilistic
MBR-006130CLM-429457
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009848
Orphan claim re-pointed
Claims processor
CLM-406541 → UHC-80241-67 (Walter Phillips)
Member id
UHC-80241-67
Confidence
1
Method
probabilistic
MBR-008933CLM-406541
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009849
Orphan claim re-pointed
Claims processor
CLM-411228 → UHC-00788-94 (Jacob Vasquez)
Member id
UHC-00788-94
Confidence
0.97
Method
deterministic
MBR-021300CLM-411228
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009850
Orphan claim re-pointed
Claims processor
CLM-432725 → UHC-88260-03 (Ana Adams)
Member id
UHC-88260-03
Confidence
1
Method
probabilistic
MBR-003292CLM-432725
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009851
Orphan claim re-pointed
Claims processor
CLM-407461 → UHC-46515-10 (Carolyn Palmer)
Member id
UHC-46515-10
Confidence
1
Method
probabilistic
MBR-025234CLM-407461
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009852
Orphan claim re-pointed
Claims processor
CLM-428558 → UHC-17373-66 (Natalie Phillips)
Member id
UHC-17373-66
Confidence
0.97
Method
deterministic
MBR-037802CLM-428558
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009853
Orphan claim re-pointed
Claims processor
CLM-407918 → UHC-28103-90 (Debra Price)
Member id
UHC-28103-90
Confidence
1
Method
probabilistic
MBR-017866CLM-407918
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009854
Orphan claim re-pointed
Claims processor
CLM-409407 → UHC-98890-36 (Mason Munoz)
Member id
UHC-98890-36
Confidence
1
Method
probabilistic
MBR-018332CLM-409407
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009855
Orphan claim re-pointed
Claims processor
CLM-423091 → UHC-11916-11 (Amber Watkins)
Member id
UHC-11916-11
Confidence
1
Method
probabilistic
MBR-009897CLM-423091
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009856
Orphan claim re-pointed
Claims processor
CLM-415846 → UHC-87921-34 (Kayla Simmons)
Member id
UHC-87921-34
Confidence
1
Method
probabilistic
MBR-020387CLM-415846
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009857
Orphan claim re-pointed
Claims processor
CLM-431080 → UHC-96916-94 (Mei Vega)
Member id
UHC-96916-94
Confidence
0.97
Method
deterministic
MBR-019204CLM-431080
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009858
Orphan claim re-pointed
Claims processor
CLM-404244 → UHC-31003-23 (Matthew Carroll)
Member id
UHC-31003-23
Confidence
0.99
Method
probabilistic
MBR-035047CLM-404244
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009859
Orphan claim re-pointed
Claims processor
CLM-411837 → UHC-67677-60 (Sarah Nguyen)
Member id
UHC-67677-60
Confidence
1
Method
probabilistic
MBR-003899CLM-411837
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009860
Orphan claim re-pointed
Claims processor
CLM-416680 → UHC-27472-49 (Dorothy Wagner)
Member id
UHC-27472-49
Confidence
1
Method
probabilistic
MBR-001127CLM-416680
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009861
Orphan claim re-pointed
Claims processor
CLM-420184 → UHC-60924-40 (Brenda Clark)
Member id
UHC-60924-40
Confidence
1
Method
probabilistic
MBR-005181CLM-420184
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009862
Orphan claim re-pointed
Claims processor
CLM-405662 → UHC-75741-56 (Brenda Bennett)
Member id
UHC-75741-56
Confidence
1
Method
probabilistic
MBR-017760CLM-405662
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009863
Orphan claim re-pointed
Claims processor
CLM-423213 → UHC-90829-10 (Andrea Stewart)
Member id
UHC-90829-10
Confidence
1
Method
probabilistic
MBR-028566CLM-423213
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009864
Orphan claim re-pointed
Claims processor
CLM-417169 → UHC-83297-25 (Nicholas Rodriguez)
Member id
UHC-83297-25
Confidence
0.97
Method
deterministic
MBR-011941CLM-417169
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009865
Orphan claim re-pointed
Claims processor
CLM-403947 → UHC-69417-14 (Ralph Garza)
Member id
UHC-69417-14
Confidence
1
Method
probabilistic
MBR-039721CLM-403947
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009866
Orphan claim re-pointed
Claims processor
CLM-407717 → UHC-04228-65 (Ann Murray)
Member id
UHC-04228-65
Confidence
0.97
Method
deterministic
MBR-000797CLM-407717
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009867
Orphan claim re-pointed
Claims processor
CLM-427647 → UHC-41265-38 (Sofia Arnold)
Member id
UHC-41265-38
Confidence
1
Method
probabilistic
MBR-020867CLM-427647
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009868
Orphan claim re-pointed
Claims processor
CLM-404996 → UHC-63573-13 (Bruce Bowman)
Member id
UHC-63573-13
Confidence
1
Method
probabilistic
MBR-009343CLM-404996
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009869
Orphan claim re-pointed
Claims processor
CLM-430551 → UHC-18319-88 (Alexander Lawrence)
Member id
UHC-18319-88
Confidence
1
Method
probabilistic
MBR-030479CLM-430551
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009870
Orphan claim re-pointed
Claims processor
CLM-417966 → UHC-92206-23 (Sofia Ramirez)
Member id
UHC-92206-23
Confidence
1
Method
probabilistic
MBR-023835CLM-417966
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009871
Orphan claim re-pointed
Claims processor
CLM-420671 → UHC-76703-06 (Russell Hart)
Member id
UHC-76703-06
Confidence
1
Method
probabilistic
MBR-037537CLM-420671
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009872
Orphan claim re-pointed
Claims processor
CLM-412517 → UHC-33554-79 (Kathleen Munoz)
Member id
UHC-33554-79
Confidence
0.97
Method
deterministic
MBR-020928CLM-412517
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009873
Orphan claim re-pointed
Claims processor
CLM-422631 → UHC-17270-31 (Thomas Hicks)
Member id
UHC-17270-31
Confidence
0.97
Method
deterministic
MBR-020623CLM-422631
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009874
Orphan claim re-pointed
Claims processor
CLM-415624 → UHC-45899-75 (Donna Weaver)
Member id
UHC-45899-75
Confidence
0.97
Method
deterministic
MBR-009021CLM-415624
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009875
Orphan claim re-pointed
Claims processor
CLM-413146 → UHC-89695-64 (Ann McCoy)
Member id
UHC-89695-64
Confidence
1
Method
probabilistic
MBR-012828CLM-413146
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009876
Orphan claim re-pointed
Claims processor
CLM-408112 → UHC-56346-66 (Pamela Jackson)
Member id
UHC-56346-66
Confidence
0.97
Method
deterministic
MBR-033990CLM-408112
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009877
Orphan claim re-pointed
Claims processor
CLM-426816 → UHC-17778-93 (Stephanie Ward)
Member id
UHC-17778-93
Confidence
0.99
Method
probabilistic
MBR-008000CLM-426816
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009878
Orphan claim re-pointed
Claims processor
CLM-425409 → UHC-57765-55 (Kelly Herrera)
Member id
UHC-57765-55
Confidence
1
Method
probabilistic
MBR-025064CLM-425409
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009879
Orphan claim re-pointed
Claims processor
CLM-408845 → UHC-76478-80 (Aaron Andrews)
Member id
UHC-76478-80
Confidence
1
Method
probabilistic
MBR-029226CLM-408845
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009880
Orphan claim re-pointed
Claims processor
CLM-413278 → UHC-59861-38 (Katherne King)
Member id
UHC-59861-38
Confidence
1.00
Method
probabilistic
MBR-002485CLM-413278
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009881
Orphan claim re-pointed
Claims processor
CLM-430089 → UHC-90833-77 (Albert Thompson)
Member id
UHC-90833-77
Confidence
0.97
Method
deterministic
MBR-045426CLM-430089
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009882
Orphan claim re-pointed
Claims processor
CLM-418987 → UHC-07701-06 (Ahmed Sanders)
Member id
UHC-07701-06
Confidence
1
Method
probabilistic
MBR-017329CLM-418987
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009883
Orphan claim re-pointed
Claims processor
CLM-423085 → UHC-00835-26 (Ana Knight)
Member id
UHC-00835-26
Confidence
1
Method
probabilistic
MBR-027941CLM-423085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009884
Orphan claim re-pointed
Claims processor
CLM-422389 → UHC-11754-06 (Carolyn McCcoy)
Member id
UHC-11754-06
Confidence
0.92
Method
probabilistic
MBR-009905CLM-422389
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009885
Orphan claim re-pointed
Claims processor
CLM-418455 → UHC-61001-47 (Lawrence Morris)
Member id
UHC-61001-47
Confidence
1
Method
probabilistic
MBR-011104CLM-418455
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009886
Orphan claim re-pointed
Claims processor
CLM-424095 → UHC-37073-66 (Nicole Gonzalez)
Member id
UHC-37073-66
Confidence
1
Method
probabilistic
MBR-003217CLM-424095
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009887
Orphan claim re-pointed
Claims processor
CLM-417980 → UHC-61124-09 (Scott Scott)
Member id
UHC-61124-09
Confidence
1
Method
probabilistic
MBR-001912CLM-417980
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009888
Orphan claim re-pointed
Claims processor
CLM-415909 → UHC-91345-99 (Alexis Reynolds)
Member id
UHC-91345-99
Confidence
1
Method
probabilistic
MBR-022108CLM-415909
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009889
Orphan claim re-pointed
Claims processor
CLM-401732 → UHC-21221-38 (Priya Bryant)
Member id
UHC-21221-38
Confidence
1
Method
probabilistic
MBR-021734CLM-401732
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 171 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.