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-010440
Orphan claim re-pointed
Claims processor
CLM-420349 → UHC-70497-07 (Evelyn Ramos)
Member id
UHC-70497-07
Confidence
1
Method
probabilistic
MBR-004230CLM-420349
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010441
Orphan claim re-pointed
Claims processor
CLM-414781 → UHC-95355-13 (Scott Bryant)
Member id
UHC-95355-13
Confidence
1
Method
probabilistic
MBR-019178CLM-414781
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010442
Orphan claim re-pointed
Claims processor
CLM-407028 → UHC-94935-25 (Christian Yang)
Member id
UHC-94935-25
Confidence
0.97
Method
deterministic
MBR-023104CLM-407028
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010443
Orphan claim re-pointed
Claims processor
CLM-425819 → UHC-57021-61 (Christine Wagner)
Member id
UHC-57021-61
Confidence
1
Method
probabilistic
MBR-007869CLM-425819
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010444
Orphan claim re-pointed
Claims processor
CLM-428704 → UHC-76593-95 (Kathryn Carlson)
Member id
UHC-76593-95
Confidence
1
Method
probabilistic
MBR-008784CLM-428704
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010445
Orphan claim re-pointed
Claims processor
CLM-405310 → UHC-37282-88 (Judith Larson)
Member id
UHC-37282-88
Confidence
0.97
Method
deterministic
MBR-025371CLM-405310
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010446
Orphan claim re-pointed
Claims processor
CLM-428159 → UHC-56916-28 (Logan Larson)
Member id
UHC-56916-28
Confidence
0.89
Method
probabilistic
MBR-019372CLM-428159
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010447
Orphan claim re-pointed
Claims processor
CLM-401437 → UHC-29726-97 (Victoria Diaz)
Member id
UHC-29726-97
Confidence
1
Method
probabilistic
MBR-039101CLM-401437
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010448
Orphan claim re-pointed
Claims processor
CLM-415904 → UHC-11243-09 (Jordan Young)
Member id
UHC-11243-09
Confidence
1
Method
probabilistic
MBR-002842CLM-415904
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010449
Orphan claim re-pointed
Claims processor
CLM-427353 → UHC-51600-71 (Christina Olson)
Member id
UHC-51600-71
Confidence
1
Method
probabilistic
MBR-000328CLM-427353
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010450
Orphan claim re-pointed
Claims processor
CLM-405181 → UHC-97377-90 (Marilyn Aguilar)
Member id
UHC-97377-90
Confidence
0.97
Method
deterministic
MBR-002876CLM-405181
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010451
Orphan claim re-pointed
Claims processor
CLM-410524 → UHC-45319-60 (Ann Hudson)
Member id
UHC-45319-60
Confidence
1
Method
probabilistic
MBR-016813CLM-410524
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 183 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.