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-003140
Orphan claim re-pointed
Claims processor
CLM-429419 → UHC-97480-71 (Billy Herrera)
Member id
UHC-97480-71
Confidence
0.92
Method
probabilistic
MBR-017927CLM-429419
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003141
Orphan claim re-pointed
Claims processor
CLM-414629 → UHC-86083-39 (Kathryn Gray)
Member id
UHC-86083-39
Confidence
0.97
Method
deterministic
MBR-011032CLM-414629
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003142
Orphan claim re-pointed
Claims processor
CLM-419130 → UHC-77185-29 (Albert Freeman)
Member id
UHC-77185-29
Confidence
0.97
Method
deterministic
MBR-043622CLM-419130
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003143
Orphan claim re-pointed
Claims processor
CLM-408793 → UHC-55422-71 (Nancy Simpson)
Member id
UHC-55422-71
Confidence
1
Method
probabilistic
MBR-005298CLM-408793
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003144
Orphan claim re-pointed
Claims processor
CLM-431847 → UHC-07344-39 (Roy James)
Member id
UHC-07344-39
Confidence
1
Method
probabilistic
MBR-007895CLM-431847
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003145
Orphan claim re-pointed
Claims processor
CLM-408498 → UHC-35056-20 (Alexander Carter)
Member id
UHC-35056-20
Confidence
0.97
Method
deterministic
MBR-012069CLM-408498
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003146
Orphan claim re-pointed
Claims processor
CLM-420418 → UHC-88855-86 (Samantha Hawkins)
Member id
UHC-88855-86
Confidence
1
Method
probabilistic
MBR-010581CLM-420418
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003147
Orphan claim re-pointed
Claims processor
CLM-423396 → UHC-08669-16 (Vicky Cook)
Member id
UHC-08669-16
Confidence
1
Method
probabilistic
MBR-011740CLM-423396
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003148
Orphan claim re-pointed
Claims processor
CLM-423933 → UHC-78913-28 (Sara Wallace)
Member id
UHC-78913-28
Confidence
1
Method
probabilistic
MBR-014779CLM-423933
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003149
Orphan claim re-pointed
Claims processor
CLM-412700 → UHC-12163-61 (Sara Wheeler)
Member id
UHC-12163-61
Confidence
0.97
Method
deterministic
MBR-006605CLM-412700
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003150
Orphan claim re-pointed
Claims processor
CLM-414239 → UHC-62249-83 (Jeffrey Alvarado)
Member id
UHC-62249-83
Confidence
1
Method
probabilistic
MBR-031075CLM-414239
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003151
Orphan claim re-pointed
Claims processor
CLM-414737 → UHC-89406-61 (Yuki Foster)
Member id
UHC-89406-61
Confidence
1
Method
probabilistic
MBR-004278CLM-414737
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003152
Orphan claim re-pointed
Claims processor
CLM-421543 → UHC-22001-33 (Megan Medina)
Member id
UHC-22001-33
Confidence
1
Method
probabilistic
MBR-007595CLM-421543
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003153
Orphan claim re-pointed
Claims processor
CLM-418833 → UHC-86924-33 (Henry Scott)
Member id
UHC-86924-33
Confidence
1
Method
probabilistic
MBR-014728CLM-418833
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003154
Orphan claim re-pointed
Claims processor
CLM-426448 → UHC-48090-22 (Mason Jacobs)
Member id
UHC-48090-22
Confidence
1
Method
probabilistic
MBR-004319CLM-426448
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003155
Orphan claim re-pointed
Claims processor
CLM-411658 → UHC-43847-07 (Lisa Sanchez)
Member id
UHC-43847-07
Confidence
1
Method
probabilistic
MBR-018703CLM-411658
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003156
Orphan claim re-pointed
Claims processor
CLM-421643 → UHC-93863-72 (Brenda Smith)
Member id
UHC-93863-72
Confidence
0.97
Method
deterministic
MBR-003244CLM-421643
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003157
Orphan claim re-pointed
Claims processor
CLM-430027 → UHC-82268-47 (Carolyn Li)
Member id
UHC-82268-47
Confidence
1
Method
probabilistic
MBR-002247CLM-430027
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003158
Orphan claim re-pointed
Claims processor
CLM-432795 → UHC-92761-01 (Stephen Murray)
Member id
UHC-92761-01
Confidence
1
Method
probabilistic
MBR-012594CLM-432795
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003159
Orphan claim re-pointed
Claims processor
CLM-407158 → UHC-17496-87 (Dylan Stewart)
Member id
UHC-17496-87
Confidence
1
Method
probabilistic
MBR-020815CLM-407158
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003160
Orphan claim re-pointed
Claims processor
CLM-414166 → UHC-04085-61 (Jessica Wang)
Member id
UHC-04085-61
Confidence
1.00
Method
probabilistic
MBR-019973CLM-414166
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003161
Orphan claim re-pointed
Claims processor
CLM-425451 → UHC-33272-26 (Raymond Grant)
Member id
UHC-33272-26
Confidence
0.97
Method
deterministic
MBR-015407CLM-425451
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003162
Orphan claim re-pointed
Claims processor
CLM-405741 → UHC-43823-71 (Bobby Mason)
Member id
UHC-43823-71
Confidence
0.97
Method
deterministic
MBR-030688CLM-405741
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003163
Orphan claim re-pointed
Claims processor
CLM-411919 → UHC-29398-05 (Julia Adams)
Member id
UHC-29398-05
Confidence
1
Method
probabilistic
MBR-006673CLM-411919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003164
Orphan claim re-pointed
Claims processor
CLM-410529 → UHC-98736-97 (Bradley Perkins)
Member id
UHC-98736-97
Confidence
1
Method
probabilistic
MBR-011639CLM-410529
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003165
Orphan claim re-pointed
Claims processor
CLM-428165 → UHC-53344-87 (Dylan King)
Member id
UHC-53344-87
Confidence
0.99
Method
probabilistic
MBR-015929CLM-428165
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003166
Orphan claim re-pointed
Claims processor
CLM-409038 → UHC-44473-39 (Allbert Hicks)
Member id
UHC-44473-39
Confidence
0.99
Method
probabilistic
MBR-015527CLM-409038
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003167
Orphan claim re-pointed
Claims processor
CLM-409547 → UHC-71447-86 (Stephanie Henderson)
Member id
UHC-71447-86
Confidence
1
Method
probabilistic
MBR-033434CLM-409547
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003168
Orphan claim re-pointed
Claims processor
CLM-431532 → UHC-64427-62 (Zachary Scott)
Member id
UHC-64427-62
Confidence
1
Method
probabilistic
MBR-004507CLM-431532
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003169
Orphan claim re-pointed
Claims processor
CLM-405451 → UHC-99272-28 (Jacob McDonald)
Member id
UHC-99272-28
Confidence
0.97
Method
deterministic
MBR-006548CLM-405451
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003170
Orphan claim re-pointed
Claims processor
CLM-430363 → UHC-76562-94 (Janet Reed)
Member id
UHC-76562-94
Confidence
1
Method
probabilistic
MBR-031290CLM-430363
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003171
Orphan claim re-pointed
Claims processor
CLM-427582 → UHC-53260-05 (Ralph Peterson)
Member id
UHC-53260-05
Confidence
1
Method
probabilistic
MBR-006611CLM-427582
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003172
Orphan claim re-pointed
Claims processor
CLM-429705 → UHC-09752-86 (Joshua Park)
Member id
UHC-09752-86
Confidence
1
Method
probabilistic
MBR-022251CLM-429705
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003173
Orphan claim re-pointed
Claims processor
CLM-414906 → UHC-54824-57 (Joe Edwardds)
Member id
UHC-54824-57
Confidence
0.97
Method
deterministic
MBR-025175CLM-414906
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003174
Orphan claim re-pointed
Claims processor
CLM-422247 → UHC-48942-70 (Janice Wong)
Member id
UHC-48942-70
Confidence
1
Method
probabilistic
MBR-027774CLM-422247
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003175
Orphan claim re-pointed
Claims processor
CLM-419942 → UHC-60747-77 (Robert Price)
Member id
UHC-60747-77
Confidence
0.97
Method
deterministic
MBR-002869CLM-419942
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003176
Orphan claim re-pointed
Claims processor
CLM-401881 → UHC-51254-08 (Patricia Wood)
Member id
UHC-51254-08
Confidence
1
Method
probabilistic
MBR-027385CLM-401881
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003177
Orphan claim re-pointed
Claims processor
CLM-428146 → UHC-37090-48 (Mei Tran)
Member id
UHC-37090-48
Confidence
1
Method
probabilistic
MBR-014722CLM-428146
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003178
Orphan claim re-pointed
Claims processor
CLM-414795 → UHC-80952-81 (Pamela Butler)
Member id
UHC-80952-81
Confidence
0.99
Method
probabilistic
MBR-011664CLM-414795
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003179
Orphan claim re-pointed
Claims processor
CLM-419260 → UHC-44427-94 (Stephen Grant)
Member id
UHC-44427-94
Confidence
1
Method
probabilistic
MBR-020418CLM-419260
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003180
Orphan claim re-pointed
Claims processor
CLM-418919 → UHC-08048-85 (Melissa Harvey)
Member id
UHC-08048-85
Confidence
1
Method
probabilistic
MBR-022498CLM-418919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003181
Orphan claim re-pointed
Claims processor
CLM-421620 → UHC-86083-05 (Teresa Chavez)
Member id
UHC-86083-05
Confidence
1.00
Method
probabilistic
MBR-006342CLM-421620
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003182
Orphan claim re-pointed
Claims processor
CLM-418873 → UHC-44238-24 (Joseph Webb)
Member id
UHC-44238-24
Confidence
0.97
Method
deterministic
MBR-010315CLM-418873
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003183
Orphan claim re-pointed
Claims processor
CLM-408331 → UHC-50574-71 (Rebecca Wilson)
Member id
UHC-50574-71
Confidence
0.97
Method
deterministic
MBR-011231CLM-408331
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003184
Orphan claim re-pointed
Claims processor
CLM-402723 → UHC-35765-08 (Gerald Jones)
Member id
UHC-35765-08
Confidence
0.99
Method
probabilistic
MBR-037013CLM-402723
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003185
Orphan claim re-pointed
Claims processor
CLM-403970 → UHC-48286-43 (Kenneth Tucker)
Member id
UHC-48286-43
Confidence
1
Method
probabilistic
MBR-021246CLM-403970
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003186
Orphan claim re-pointed
Claims processor
CLM-406890 → UHC-96152-36 (Priya Cook)
Member id
UHC-96152-36
Confidence
1
Method
probabilistic
MBR-006563CLM-406890
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003187
Orphan claim re-pointed
Claims processor
CLM-412126 → UHC-98227-66 (Fatima Robertson)
Member id
UHC-98227-66
Confidence
0.97
Method
deterministic
MBR-008964CLM-412126
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003188
Orphan claim re-pointed
Claims processor
CLM-429234 → UHC-11118-67 (Natalie Bennett)
Member id
UHC-11118-67
Confidence
1
Method
probabilistic
MBR-021349CLM-429234
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003189
Orphan claim re-pointed
Claims processor
CLM-408969 → UHC-27109-52 (Megan Bradley)
Member id
UHC-27109-52
Confidence
1
Method
probabilistic
MBR-001625CLM-408969
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 37 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.