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-002640
Orphan claim re-pointed
Claims processor
CLM-402404 → UHC-38979-10 (Anthony Brooks)
Member id
UHC-38979-10
Confidence
0.97
Method
deterministic
MBR-011676CLM-402404
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002641
Orphan claim re-pointed
Claims processor
CLM-426214 → UHC-86599-46 (Nancy Peters)
Member id
UHC-86599-46
Confidence
1
Method
probabilistic
MBR-010257CLM-426214
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002642
Orphan claim re-pointed
Claims processor
CLM-403473 → UHC-95401-16 (Kathryn Pierce)
Member id
UHC-95401-16
Confidence
0.98
Method
probabilistic
MBR-006669CLM-403473
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002643
Orphan claim re-pointed
Claims processor
CLM-422789 → UHC-54154-91 (Joseph Walsh)
Member id
UHC-54154-91
Confidence
0.97
Method
deterministic
MBR-019891CLM-422789
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002644
Orphan claim re-pointed
Claims processor
CLM-422581 → UHC-99859-68 (Helen Sanders)
Member id
UHC-99859-68
Confidence
1
Method
probabilistic
MBR-013664CLM-422581
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002645
Orphan claim re-pointed
Claims processor
CLM-423376 → UHC-34873-65 (Jacob Cruz)
Member id
UHC-34873-65
Confidence
0.86
Method
probabilistic
MBR-019783CLM-423376
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002646
Orphan claim re-pointed
Claims processor
CLM-401971 → UHC-96149-83 (David Davis)
Member id
UHC-96149-83
Confidence
1
Method
probabilistic
MBR-013758CLM-401971
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002647
Orphan claim re-pointed
Claims processor
CLM-409537 → UHC-10812-76 (Beverly Bailey)
Member id
UHC-10812-76
Confidence
1
Method
probabilistic
MBR-010356CLM-409537
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002648
Orphan claim re-pointed
Claims processor
CLM-408037 → UHC-95096-66 (Scott Pena)
Member id
UHC-95096-66
Confidence
0.97
Method
deterministic
MBR-004165CLM-408037
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002649
Orphan claim re-pointed
Claims processor
CLM-429779 → UHC-55669-57 (Elizabeth Grant)
Member id
UHC-55669-57
Confidence
0.98
Method
probabilistic
MBR-023026CLM-429779
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002650
Orphan claim re-pointed
Claims processor
CLM-419997 → UHC-67314-03 (Keith Meyer)
Member id
UHC-67314-03
Confidence
1
Method
probabilistic
MBR-030036CLM-419997
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002651
Orphan claim re-pointed
Claims processor
CLM-407194 → UHC-12421-61 (Emma Crawford)
Member id
UHC-12421-61
Confidence
0.93
Method
probabilistic
MBR-022447CLM-407194
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002652
Orphan claim re-pointed
Claims processor
CLM-406357 → UHC-29473-65 (Charlotte Green)
Member id
UHC-29473-65
Confidence
0.97
Method
deterministic
MBR-003716CLM-406357
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002653
Orphan claim re-pointed
Claims processor
CLM-406368 → UHC-10686-47 (Carlos Austin)
Member id
UHC-10686-47
Confidence
1.00
Method
probabilistic
MBR-029976CLM-406368
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002654
Orphan claim re-pointed
Claims processor
CLM-428094 → UHC-87638-87 (Melissa Hawkins)
Member id
UHC-87638-87
Confidence
1
Method
probabilistic
MBR-010095CLM-428094
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002655
Orphan claim re-pointed
Claims processor
CLM-423316 → UHC-73613-10 (Willie Hill)
Member id
UHC-73613-10
Confidence
1
Method
probabilistic
MBR-004900CLM-423316
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002656
Orphan claim re-pointed
Claims processor
CLM-401516 → UHC-49554-66 (Alice Le)
Member id
UHC-49554-66
Confidence
1
Method
probabilistic
MBR-007176CLM-401516
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002657
Orphan claim re-pointed
Claims processor
CLM-415891 → UHC-84904-40 (Wayne Guarrero)
Member id
UHC-84904-40
Confidence
0.97
Method
probabilistic
MBR-026013CLM-415891
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002658
Orphan claim re-pointed
Claims processor
CLM-414386 → UHC-37191-06 (Kayla Flores)
Member id
UHC-37191-06
Confidence
1
Method
probabilistic
MBR-010181CLM-414386
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002659
Orphan claim re-pointed
Claims processor
CLM-414523 → UHC-44172-99 (Mariana Walker)
Member id
UHC-44172-99
Confidence
1
Method
probabilistic
MBR-005933CLM-414523
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002660
Orphan claim re-pointed
Claims processor
CLM-430505 → UHC-78632-10 (Kevin Andrews)
Member id
UHC-78632-10
Confidence
1
Method
probabilistic
MBR-023694CLM-430505
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002661
Orphan claim re-pointed
Claims processor
CLM-429518 → UHC-80595-34 (Julia Luna)
Member id
UHC-80595-34
Confidence
0.97
Method
deterministic
MBR-006921CLM-429518
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002662
Orphan claim re-pointed
Claims processor
CLM-428009 → UHC-38382-18 (Sophia Johnston)
Member id
UHC-38382-18
Confidence
0.97
Method
deterministic
MBR-023074CLM-428009
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002663
Orphan claim re-pointed
Claims processor
CLM-401896 → UHC-66047-99 (Ruth Larson)
Member id
UHC-66047-99
Confidence
1
Method
probabilistic
MBR-005350CLM-401896
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002664
Orphan claim re-pointed
Claims processor
CLM-421602 → UHC-05399-64 (Shirley Gilbert)
Member id
UHC-05399-64
Confidence
1
Method
probabilistic
MBR-006765CLM-421602
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002665
Orphan claim re-pointed
Claims processor
CLM-401746 → UHC-06356-65 (Bradley Rice)
Member id
UHC-06356-65
Confidence
0.97
Method
deterministic
MBR-027357CLM-401746
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002666
Orphan claim re-pointed
Claims processor
CLM-424687 → UHC-93030-14 (Teresa Johnson)
Member id
UHC-93030-14
Confidence
0.99
Method
probabilistic
MBR-015085CLM-424687
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002667
Orphan claim re-pointed
Claims processor
CLM-408686 → UHC-77500-44 (Evelyn Ramos)
Member id
UHC-77500-44
Confidence
1
Method
probabilistic
MBR-001377CLM-408686
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002668
Orphan claim re-pointed
Claims processor
CLM-429281 → UHC-47017-38 (Larson Lori)
Member id
UHC-47017-38
Confidence
0.98
Method
probabilistic
MBR-036882CLM-429281
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002669
Orphan claim re-pointed
Claims processor
CLM-417702 → UHC-65290-08 (Elizabeth Stephens)
Member id
UHC-65290-08
Confidence
1
Method
probabilistic
MBR-007360CLM-417702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002670
Orphan claim re-pointed
Claims processor
CLM-427725 → UHC-47612-02 (Albert Delgado)
Member id
UHC-47612-02
Confidence
0.97
Method
deterministic
MBR-009146CLM-427725
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002671
Orphan claim re-pointed
Claims processor
CLM-426738 → UHC-52496-34 (Camila Kim)
Member id
UHC-52496-34
Confidence
1
Method
probabilistic
MBR-011329CLM-426738
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002672
Orphan claim re-pointed
Claims processor
CLM-429313 → UHC-34231-96 (Joseph Hanson)
Member id
UHC-34231-96
Confidence
1
Method
probabilistic
MBR-015461CLM-429313
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002673
Orphan claim re-pointed
Claims processor
CLM-413804 → UHC-39549-73 (Henry Johnson)
Member id
UHC-39549-73
Confidence
1
Method
probabilistic
MBR-006125CLM-413804
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002674
Orphan claim re-pointed
Claims processor
CLM-421303 → UHC-41567-67 (Chris Ferguson)
Member id
UHC-41567-67
Confidence
1
Method
probabilistic
MBR-009596CLM-421303
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002675
Orphan claim re-pointed
Claims processor
CLM-422027 → UHC-84353-34 (Cynthia Jenkins)
Member id
UHC-84353-34
Confidence
1
Method
probabilistic
MBR-027951CLM-422027
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002676
Orphan claim re-pointed
Claims processor
CLM-418162 → UHC-42273-50 (Dorothy Bailey)
Member id
UHC-42273-50
Confidence
1
Method
probabilistic
MBR-025074CLM-418162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002677
Orphan claim re-pointed
Claims processor
CLM-426235 → UHC-19670-66 (Amanda Castillo)
Member id
UHC-19670-66
Confidence
1
Method
probabilistic
MBR-024592CLM-426235
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002678
Orphan claim re-pointed
Claims processor
CLM-430566 → UHC-34472-84 (Logan Greene)
Member id
UHC-34472-84
Confidence
1
Method
probabilistic
MBR-013376CLM-430566
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002679
Orphan claim re-pointed
Claims processor
CLM-430098 → UHC-42568-28 (Valentina Williams)
Member id
UHC-42568-28
Confidence
1
Method
probabilistic
MBR-002396CLM-430098
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002680
Orphan claim re-pointed
Claims processor
CLM-420025 → UHC-42568-66 (Kayla Richards)
Member id
UHC-42568-66
Confidence
1
Method
probabilistic
MBR-009104CLM-420025
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002681
Orphan claim re-pointed
Claims processor
CLM-407528 → UHC-43700-15 (Justin Little)
Member id
UHC-43700-15
Confidence
0.97
Method
deterministic
MBR-006682CLM-407528
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002682
Orphan claim re-pointed
Claims processor
CLM-425852 → UHC-90457-58 (Alexis Mitchell)
Member id
UHC-90457-58
Confidence
1
Method
probabilistic
MBR-010288CLM-425852
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002683
Orphan claim re-pointed
Claims processor
CLM-410117 → UHC-23636-43 (Cheryl Vazquez)
Member id
UHC-23636-43
Confidence
1
Method
probabilistic
MBR-018548CLM-410117
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002684
Orphan claim re-pointed
Claims processor
CLM-403864 → UHC-70659-16 (Megan Richardson)
Member id
UHC-70659-16
Confidence
0.88
Method
probabilistic
MBR-033626CLM-403864
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002685
Orphan claim re-pointed
Claims processor
CLM-418702 → UHC-85993-86 (Paul Martinez)
Member id
UHC-85993-86
Confidence
0.97
Method
deterministic
MBR-025859CLM-418702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002686
Orphan claim re-pointed
Claims processor
CLM-423340 → UHC-29270-37 (Robert Watkins)
Member id
UHC-29270-37
Confidence
1
Method
probabilistic
MBR-012317CLM-423340
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002687
Orphan claim re-pointed
Claims processor
CLM-432519 → UHC-90246-63 (Joe Stevens)
Member id
UHC-90246-63
Confidence
1
Method
probabilistic
MBR-014923CLM-432519
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002688
Orphan claim re-pointed
Claims processor
CLM-402089 → UHC-88323-46 (Thomas Harvey)
Member id
UHC-88323-46
Confidence
1
Method
probabilistic
MBR-017601CLM-402089
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002689
Orphan claim re-pointed
Claims processor
CLM-431876 → UHC-49823-74 (Patrick Padilla)
Member id
UHC-49823-74
Confidence
0.97
Method
deterministic
MBR-020833CLM-431876
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 27 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.