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-010340
Orphan claim re-pointed
Claims processor
CLM-424371 → UHC-51097-26 (Roger Sanders)
Member id
UHC-51097-26
Confidence
0.94
Method
probabilistic
MBR-007736CLM-424371
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010341
Orphan claim re-pointed
Claims processor
CLM-406034 → UHC-48655-61 (Maria Chapman)
Member id
UHC-48655-61
Confidence
0.97
Method
deterministic
MBR-033332CLM-406034
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010342
Orphan claim re-pointed
Claims processor
CLM-415476 → UHC-34102-43 (Paul Little)
Member id
UHC-34102-43
Confidence
1
Method
probabilistic
MBR-027135CLM-415476
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010343
Orphan claim re-pointed
Claims processor
CLM-413873 → UHC-53988-81 (Teresa Meyer)
Member id
UHC-53988-81
Confidence
1.00
Method
probabilistic
MBR-038235CLM-413873
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010344
Orphan claim re-pointed
Claims processor
CLM-406700 → UHC-64707-24 (Mary Vazquez)
Member id
UHC-64707-24
Confidence
0.97
Method
deterministic
MBR-004406CLM-406700
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010345
Orphan claim re-pointed
Claims processor
CLM-419663 → UHC-58484-01 (Beverly Lynch)
Member id
UHC-58484-01
Confidence
1
Method
probabilistic
MBR-008525CLM-419663
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010346
Orphan claim re-pointed
Claims processor
CLM-427985 → UHC-90343-90 (Elijah Padilla)
Member id
UHC-90343-90
Confidence
1
Method
probabilistic
MBR-011110CLM-427985
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010347
Orphan claim re-pointed
Claims processor
CLM-405351 → UHC-72880-67 (Barbara Simmons)
Member id
UHC-72880-67
Confidence
1
Method
probabilistic
MBR-032400CLM-405351
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010348
Orphan claim re-pointed
Claims processor
CLM-407800 → UHC-31792-15 (Lisa Berry)
Member id
UHC-31792-15
Confidence
1
Method
probabilistic
MBR-028476CLM-407800
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010349
Orphan claim re-pointed
Claims processor
CLM-410888 → UHC-63529-48 (Hannah Dixon)
Member id
UHC-63529-48
Confidence
0.97
Method
deterministic
MBR-028344CLM-410888
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010350
Orphan claim re-pointed
Claims processor
CLM-401300 → UHC-33261-46 (Vincet Sanders)
Member id
UHC-33261-46
Confidence
1.00
Method
probabilistic
MBR-040581CLM-401300
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010351
Orphan claim re-pointed
Claims processor
CLM-414522 → UHC-46817-61 (Mateo Perez)
Member id
UHC-46817-61
Confidence
1
Method
probabilistic
MBR-017686CLM-414522
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010352
Orphan claim re-pointed
Claims processor
CLM-401853 → UHC-58248-42 (Edward Dunn)
Member id
UHC-58248-42
Confidence
1
Method
probabilistic
MBR-029930CLM-401853
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010353
Orphan claim re-pointed
Claims processor
CLM-406763 → UHC-30409-08 (Kathy Baker)
Member id
UHC-30409-08
Confidence
1
Method
probabilistic
MBR-002655CLM-406763
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010354
Orphan claim re-pointed
Claims processor
CLM-425969 → UHC-84938-93 (Sophia Walker)
Member id
UHC-84938-93
Confidence
1
Method
probabilistic
MBR-001014CLM-425969
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010355
Orphan claim re-pointed
Claims processor
CLM-407583 → UHC-33507-83 (Joe Welkh)
Member id
UHC-33507-83
Confidence
0.97
Method
deterministic
MBR-001782CLM-407583
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010356
Orphan claim re-pointed
Claims processor
CLM-424415 → UHC-85600-23 (Noah Cooper)
Member id
UHC-85600-23
Confidence
1
Method
probabilistic
MBR-019191CLM-424415
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010357
Orphan claim re-pointed
Claims processor
CLM-407915 → UHC-74491-09 (Gabriel Castro)
Member id
UHC-74491-09
Confidence
0.93
Method
probabilistic
MBR-033358CLM-407915
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010358
Orphan claim re-pointed
Claims processor
CLM-422719 → UHC-39775-45 (Bobby Simpson)
Member id
UHC-39775-45
Confidence
1
Method
probabilistic
MBR-020956CLM-422719
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010359
Orphan claim re-pointed
Claims processor
CLM-406313 → UHC-37922-39 (Cheryl Grant)
Member id
UHC-37922-39
Confidence
1
Method
probabilistic
MBR-013813CLM-406313
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010360
Orphan claim re-pointed
Claims processor
CLM-412620 → UHC-67711-06 (Christina Tucker)
Member id
UHC-67711-06
Confidence
1
Method
probabilistic
MBR-001186CLM-412620
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010361
Orphan claim re-pointed
Claims processor
CLM-406186 → UHC-18080-63 (Eugene Sanchez)
Member id
UHC-18080-63
Confidence
1
Method
probabilistic
MBR-014657CLM-406186
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010362
Orphan claim re-pointed
Claims processor
CLM-429462 → UHC-53838-39 (Lucia Le)
Member id
UHC-53838-39
Confidence
1
Method
probabilistic
MBR-012844CLM-429462
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010363
Orphan claim re-pointed
Claims processor
CLM-427111 → UHC-98826-91 (Isabella Barnes)
Member id
UHC-98826-91
Confidence
1
Method
probabilistic
MBR-018152CLM-427111
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010364
Orphan claim re-pointed
Claims processor
CLM-404549 → UHC-96000-34 (Teresa Washington)
Member id
UHC-96000-34
Confidence
1
Method
probabilistic
MBR-014328CLM-404549
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010365
Orphan claim re-pointed
Claims processor
CLM-430125 → UHC-30205-72 (Mariana Nelson)
Member id
UHC-30205-72
Confidence
1
Method
probabilistic
MBR-009489CLM-430125
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010366
Orphan claim re-pointed
Claims processor
CLM-432013 → UHC-49736-25 (Doris Nunez)
Member id
UHC-49736-25
Confidence
1
Method
probabilistic
MBR-006293CLM-432013
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010367
Orphan claim re-pointed
Claims processor
CLM-417662 → UHC-99615-18 (Mark Edwards)
Member id
UHC-99615-18
Confidence
1
Method
probabilistic
MBR-028841CLM-417662
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010368
Orphan claim re-pointed
Claims processor
CLM-408028 → UHC-48323-60 (Nicholas Salazar)
Member id
UHC-48323-60
Confidence
0.97
Method
deterministic
MBR-033527CLM-408028
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010369
Orphan claim re-pointed
Claims processor
CLM-404094 → UHC-37776-09 (Anna Griffin)
Member id
UHC-37776-09
Confidence
1
Method
probabilistic
MBR-018743CLM-404094
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010370
Orphan claim re-pointed
Claims processor
CLM-417085 → UHC-35055-31 (Alice Graham)
Member id
UHC-35055-31
Confidence
1
Method
probabilistic
MBR-021569CLM-417085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010371
Orphan claim re-pointed
Claims processor
CLM-418967 → UHC-02731-78 (Charles Sullivan)
Member id
UHC-02731-78
Confidence
1
Method
probabilistic
MBR-028353CLM-418967
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010372
Orphan claim re-pointed
Claims processor
CLM-406243 → UHC-68255-89 (Jeremy Walker)
Member id
UHC-68255-89
Confidence
1
Method
probabilistic
MBR-008505CLM-406243
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010373
Orphan claim re-pointed
Claims processor
CLM-412609 → UHC-08541-69 (Sandra Nelson)
Member id
UHC-08541-69
Confidence
0.97
Method
deterministic
MBR-005819CLM-412609
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010374
Orphan claim re-pointed
Claims processor
CLM-422646 → UHC-19675-29 (Philip Vasquez)
Member id
UHC-19675-29
Confidence
1
Method
probabilistic
MBR-029010CLM-422646
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010375
Orphan claim re-pointed
Claims processor
CLM-422311 → UHC-37542-71 (Vincent Thomas)
Member id
UHC-37542-71
Confidence
0.97
Method
deterministic
MBR-029506CLM-422311
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010376
Orphan claim re-pointed
Claims processor
CLM-425995 → UHC-36504-88 (Diego Daniels)
Member id
UHC-36504-88
Confidence
0.97
Method
deterministic
MBR-010148CLM-425995
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010377
Orphan claim re-pointed
Claims processor
CLM-410643 → UHC-13303-97 (Rachel Patterson)
Member id
UHC-13303-97
Confidence
1
Method
probabilistic
MBR-038686CLM-410643
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010378
Orphan claim re-pointed
Claims processor
CLM-419201 → UHC-40453-51 (Kyle Carroll)
Member id
UHC-40453-51
Confidence
0.97
Method
deterministic
MBR-027187CLM-419201
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010379
Orphan claim re-pointed
Claims processor
CLM-426763 → UHC-93876-66 (Brian Stone)
Member id
UHC-93876-66
Confidence
1
Method
probabilistic
MBR-000904CLM-426763
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010380
Orphan claim re-pointed
Claims processor
CLM-416997 → UHC-76184-54 (Abigail Gomez)
Member id
UHC-76184-54
Confidence
0.97
Method
deterministic
MBR-024876CLM-416997
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010381
Orphan claim re-pointed
Claims processor
CLM-412606 → UHC-28401-72 (Lori Campbell)
Member id
UHC-28401-72
Confidence
1
Method
probabilistic
MBR-018997CLM-412606
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010382
Orphan claim re-pointed
Claims processor
CLM-420826 → UHC-93150-43 (George Foster)
Member id
UHC-93150-43
Confidence
1
Method
probabilistic
MBR-007737CLM-420826
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010383
Orphan claim re-pointed
Claims processor
CLM-403251 → UHC-01029-95 (Jack Fisher)
Member id
UHC-01029-95
Confidence
0.93
Method
probabilistic
MBR-005555CLM-403251
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010384
Orphan claim re-pointed
Claims processor
CLM-432785 → UHC-12321-25 (Tyler Ramirez)
Member id
UHC-12321-25
Confidence
0.97
Method
deterministic
MBR-000233CLM-432785
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010385
Orphan claim re-pointed
Claims processor
CLM-404900 → UHC-27948-29 (Zachary Gibson)
Member id
UHC-27948-29
Confidence
0.97
Method
deterministic
MBR-028895CLM-404900
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010386
Orphan claim re-pointed
Claims processor
CLM-405146 → UHC-91196-41 (Emma Reed)
Member id
UHC-91196-41
Confidence
1
Method
probabilistic
MBR-013284CLM-405146
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010387
Orphan claim re-pointed
Claims processor
CLM-421244 → UHC-67909-78 (Martha Sullivan)
Member id
UHC-67909-78
Confidence
1
Method
probabilistic
MBR-003437CLM-421244
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010388
Orphan claim re-pointed
Claims processor
CLM-400101 → UHC-16651-46 (Josh Burke)
Member id
UHC-16651-46
Confidence
0.97
Method
deterministic
MBR-013738CLM-400101
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010389
Orphan claim re-pointed
Claims processor
CLM-403571 → UHC-27047-16 (Karen Diaz)
Member id
UHC-27047-16
Confidence
0.97
Method
deterministic
MBR-005893CLM-403571
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 181 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.