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-001490
Orphan claim re-pointed
Claims processor
CLM-410279 → UHC-87261-18 (Angela Foster)
Member id
UHC-87261-18
Confidence
1
Method
probabilistic
MBR-003791CLM-410279
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001491
Orphan claim re-pointed
Claims processor
CLM-410099 → UHC-54765-40 (Rachel Hughes)
Member id
UHC-54765-40
Confidence
0.97
Method
deterministic
MBR-036850CLM-410099
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001492
Orphan claim re-pointed
Claims processor
CLM-427241 → UHC-66465-99 (Juan Richardson)
Member id
UHC-66465-99
Confidence
1
Method
probabilistic
MBR-018273CLM-427241
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001493
Orphan claim re-pointed
Claims processor
CLM-423343 → UHC-54680-35 (Amy Castro)
Member id
UHC-54680-35
Confidence
1
Method
probabilistic
MBR-019862CLM-423343
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001494
Orphan claim re-pointed
Claims processor
CLM-410003 → UHC-95791-99 (Denise Davis)
Member id
UHC-95791-99
Confidence
1
Method
probabilistic
MBR-032429CLM-410003
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001495
Orphan claim re-pointed
Claims processor
CLM-417054 → UHC-33148-70 (Roger Wagner)
Member id
UHC-33148-70
Confidence
1
Method
probabilistic
MBR-024991CLM-417054
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001496
Orphan claim re-pointed
Claims processor
CLM-425708 → UHC-50017-11 (Natalie Oliver)
Member id
UHC-50017-11
Confidence
1
Method
probabilistic
MBR-034287CLM-425708
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001497
Orphan claim re-pointed
Claims processor
CLM-407214 → UHC-59562-45 (Kimberly Munoz)
Member id
UHC-59562-45
Confidence
1
Method
probabilistic
MBR-033665CLM-407214
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001498
Orphan claim re-pointed
Claims processor
CLM-424932 → UHC-70588-83 (Mei Alvarado)
Member id
UHC-70588-83
Confidence
0.97
Method
deterministic
MBR-003692CLM-424932
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001499
Orphan claim re-pointed
Claims processor
CLM-407731 → UHC-35803-15 (Beverly Padilla)
Member id
UHC-35803-15
Confidence
1
Method
probabilistic
MBR-004517CLM-407731
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001500
Orphan claim re-pointed
Claims processor
CLM-417254 → UHC-90619-60 (Jerry Contreras)
Member id
UHC-90619-60
Confidence
0.97
Method
deterministic
MBR-027626CLM-417254
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001501
Orphan claim re-pointed
Claims processor
CLM-400428 → UHC-63000-58 (Jeremy Mitchell)
Member id
UHC-63000-58
Confidence
0.97
Method
deterministic
MBR-024892CLM-400428
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001502
Orphan claim re-pointed
Claims processor
CLM-405346 → UHC-38921-20 (Bruce Porter)
Member id
UHC-38921-20
Confidence
1
Method
probabilistic
MBR-044086CLM-405346
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001503
Orphan claim re-pointed
Claims processor
CLM-424422 → UHC-41546-10 (Dorothy Harvey)
Member id
UHC-41546-10
Confidence
1
Method
probabilistic
MBR-003784CLM-424422
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001504
Orphan claim re-pointed
Claims processor
CLM-429864 → UHC-40656-73 (Aisha Salazar)
Member id
UHC-40656-73
Confidence
1
Method
probabilistic
MBR-018975CLM-429864
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001505
Orphan claim re-pointed
Claims processor
CLM-418030 → UHC-70211-77 (Kyle Hill)
Member id
UHC-70211-77
Confidence
1
Method
probabilistic
MBR-005139CLM-418030
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001506
Orphan claim re-pointed
Claims processor
CLM-424246 → UHC-28620-79 (Katherine Hart)
Member id
UHC-28620-79
Confidence
0.93
Method
probabilistic
MBR-037324CLM-424246
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001507
Orphan claim re-pointed
Claims processor
CLM-403801 → UHC-30857-34 (Frances Jacobs)
Member id
UHC-30857-34
Confidence
1
Method
probabilistic
MBR-001116CLM-403801
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001508
Orphan claim re-pointed
Claims processor
CLM-422040 → UHC-30949-43 (Patrick Nichols)
Member id
UHC-30949-43
Confidence
1
Method
probabilistic
MBR-012564CLM-422040
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001509
Orphan claim re-pointed
Claims processor
CLM-418957 → UHC-96268-40 (Vincent Le)
Member id
UHC-96268-40
Confidence
1
Method
probabilistic
MBR-015298CLM-418957
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001510
Orphan claim re-pointed
Claims processor
CLM-424267 → UHC-58851-08 (Jack Barnes)
Member id
UHC-58851-08
Confidence
1
Method
probabilistic
MBR-005830CLM-424267
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001511
Orphan claim re-pointed
Claims processor
CLM-421836 → UHC-25678-83 (Sandra Franklin)
Member id
UHC-25678-83
Confidence
1
Method
probabilistic
MBR-024698CLM-421836
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001512
Orphan claim re-pointed
Claims processor
CLM-418422 → UHC-78519-23 (Joseph Vargas)
Member id
UHC-78519-23
Confidence
1
Method
probabilistic
MBR-036682CLM-418422
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001513
Orphan claim re-pointed
Claims processor
CLM-425536 → UHC-32494-13 (Beverly Cunningham)
Member id
UHC-32494-13
Confidence
1
Method
probabilistic
MBR-015646CLM-425536
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001514
Orphan claim re-pointed
Claims processor
CLM-428690 → UHC-92720-51 (Lucia Rios)
Member id
UHC-92720-51
Confidence
1
Method
probabilistic
MBR-006680CLM-428690
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001515
Orphan claim re-pointed
Claims processor
CLM-417737 → UHC-05335-91 (Wayne Castro)
Member id
UHC-05335-91
Confidence
1
Method
probabilistic
MBR-009948CLM-417737
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001516
Orphan claim re-pointed
Claims processor
CLM-422239 → UHC-37143-79 (Ruth Olson)
Member id
UHC-37143-79
Confidence
1
Method
probabilistic
MBR-000699CLM-422239
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001517
Orphan claim re-pointed
Claims processor
CLM-407065 → UHC-29827-19 (Brenda Wells)
Member id
UHC-29827-19
Confidence
0.97
Method
deterministic
MBR-022624CLM-407065
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001518
Orphan claim re-pointed
Claims processor
CLM-408956 → UHC-45950-02 (Andrea Carroll)
Member id
UHC-45950-02
Confidence
1
Method
probabilistic
MBR-024646CLM-408956
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001519
Orphan claim re-pointed
Claims processor
CLM-400771 → UHC-08091-97 (Angela Yang)
Member id
UHC-08091-97
Confidence
1
Method
probabilistic
MBR-001459CLM-400771
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001520
Orphan claim re-pointed
Claims processor
CLM-413032 → UHC-42291-53 (Brittany Lucas)
Member id
UHC-42291-53
Confidence
1
Method
probabilistic
MBR-006797CLM-413032
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001521
Orphan claim re-pointed
Claims processor
CLM-412305 → UHC-46510-63 (Sharon Davis)
Member id
UHC-46510-63
Confidence
0.93
Method
probabilistic
MBR-002097CLM-412305
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001522
Orphan claim re-pointed
Claims processor
CLM-420448 → UHC-93836-29 (Patrick Boyd)
Member id
UHC-93836-29
Confidence
1
Method
probabilistic
MBR-001790CLM-420448
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001523
Orphan claim re-pointed
Claims processor
CLM-412093 → UHC-85481-64 (Billy Miller)
Member id
UHC-85481-64
Confidence
0.91
Method
probabilistic
MBR-011765CLM-412093
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001524
Orphan claim re-pointed
Claims processor
CLM-408379 → UHC-10242-73 (Ralph Graham)
Member id
UHC-10242-73
Confidence
1
Method
probabilistic
MBR-000817CLM-408379
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001525
Orphan claim re-pointed
Claims processor
CLM-411624 → UHC-52847-57 (George Day)
Member id
UHC-52847-57
Confidence
1
Method
probabilistic
MBR-036396CLM-411624
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001526
Orphan claim re-pointed
Claims processor
CLM-404275 → UHC-75366-47 (Andrea Medina)
Member id
UHC-75366-47
Confidence
1
Method
probabilistic
MBR-033426CLM-404275
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001527
Orphan claim re-pointed
Claims processor
CLM-400183 → UHC-36965-72 (Anthony Ross)
Member id
UHC-36965-72
Confidence
1
Method
probabilistic
MBR-037090CLM-400183
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001528
Orphan claim re-pointed
Claims processor
CLM-413114 → UHC-12538-47 (Carol Fowler)
Member id
UHC-12538-47
Confidence
1
Method
probabilistic
MBR-018557CLM-413114
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001529
Orphan claim re-pointed
Claims processor
CLM-425087 → UHC-27960-11 (Joan Bennett)
Member id
UHC-27960-11
Confidence
1
Method
probabilistic
MBR-010174CLM-425087
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001530
Orphan claim re-pointed
Claims processor
CLM-408137 → UHC-72343-79 (Joseph Scott)
Member id
UHC-72343-79
Confidence
1
Method
probabilistic
MBR-021986CLM-408137
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001531
Orphan claim re-pointed
Claims processor
CLM-404882 → UHC-28782-70 (Kayla Williamson)
Member id
UHC-28782-70
Confidence
1
Method
probabilistic
MBR-005574CLM-404882
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001532
Orphan claim re-pointed
Claims processor
CLM-425985 → UHC-06168-30 (Michelle Jimenez)
Member id
UHC-06168-30
Confidence
1
Method
probabilistic
MBR-014439CLM-425985
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001533
Orphan claim re-pointed
Claims processor
CLM-415984 → UHC-93362-68 (Yuki Porter)
Member id
UHC-93362-68
Confidence
1
Method
probabilistic
MBR-015291CLM-415984
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001534
Orphan claim re-pointed
Claims processor
CLM-415146 → UHC-43837-44 (Carol Ramirez)
Member id
UHC-43837-44
Confidence
1
Method
probabilistic
MBR-002454CLM-415146
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001535
Orphan claim re-pointed
Claims processor
CLM-412307 → UHC-19050-02 (Isabella Black)
Member id
UHC-19050-02
Confidence
1
Method
probabilistic
MBR-041536CLM-412307
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001536
Orphan claim re-pointed
Claims processor
CLM-429977 → UHC-33868-33 (Jacob Jordan)
Member id
UHC-33868-33
Confidence
1
Method
probabilistic
MBR-017144CLM-429977
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001537
Orphan claim re-pointed
Claims processor
CLM-414118 → UHC-48894-38 (Dennis Spencer)
Member id
UHC-48894-38
Confidence
0.97
Method
deterministic
MBR-000087CLM-414118
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001538
Orphan claim re-pointed
Claims processor
CLM-410486 → UHC-98537-14 (Carolyn Price)
Member id
UHC-98537-14
Confidence
1.00
Method
probabilistic
MBR-004876CLM-410486
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001539
Orphan claim re-pointed
Claims processor
CLM-409757 → UHC-61672-34 (Aaron Lee)
Member id
UHC-61672-34
Confidence
1
Method
probabilistic
MBR-009884CLM-409757
Executed
resolution_agent
2026-10-19 19:54:39
9,112 rows, page 4 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.