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-003340
Orphan claim re-pointed
Claims processor
CLM-405372 → UHC-30911-04 (Jennifer Berry)
Member id
UHC-30911-04
Confidence
0.85
Method
probabilistic
MBR-013032CLM-405372
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003341
Orphan claim re-pointed
Claims processor
CLM-403844 → UHC-50312-75 (Kimberly Cruz)
Member id
UHC-50312-75
Confidence
1
Method
probabilistic
MBR-004978CLM-403844
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003342
Orphan claim re-pointed
Claims processor
CLM-404231 → UHC-22060-18 (Ruth McDonald)
Member id
UHC-22060-18
Confidence
0.97
Method
deterministic
MBR-015285CLM-404231
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003343
Orphan claim re-pointed
Claims processor
CLM-427303 → UHC-88625-13 (Tyler Cole)
Member id
UHC-88625-13
Confidence
1
Method
probabilistic
MBR-012645CLM-427303
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003344
Orphan claim re-pointed
Claims processor
CLM-418100 → UHC-05763-13 (Denise Ortega)
Member id
UHC-05763-13
Confidence
1
Method
probabilistic
MBR-041447CLM-418100
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003345
Orphan claim re-pointed
Claims processor
CLM-407502 → UHC-86804-48 (Camila Sandoval)
Member id
UHC-86804-48
Confidence
0.93
Method
probabilistic
MBR-020178CLM-407502
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003346
Orphan claim re-pointed
Claims processor
CLM-427404 → UHC-55073-04 (Luis Leewis)
Member id
UHC-55073-04
Confidence
0.97
Method
deterministic
MBR-039496CLM-427404
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003347
Orphan claim re-pointed
Claims processor
CLM-413350 → UHC-16028-30 (Emma Mendez)
Member id
UHC-16028-30
Confidence
1
Method
probabilistic
MBR-036381CLM-413350
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003348
Orphan claim re-pointed
Claims processor
CLM-410898 → UHC-14493-37 (Cheryl Kennedy)
Member id
UHC-14493-37
Confidence
1
Method
probabilistic
MBR-022620CLM-410898
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003349
Orphan claim re-pointed
Claims processor
CLM-403915 → UHC-34464-25 (Arthur Guzman)
Member id
UHC-34464-25
Confidence
1
Method
probabilistic
MBR-016841CLM-403915
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003350
Orphan claim re-pointed
Claims processor
CLM-431784 → UHC-85105-06 (Michelle Le)
Member id
UHC-85105-06
Confidence
0.99
Method
probabilistic
MBR-033633CLM-431784
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003351
Orphan claim re-pointed
Claims processor
CLM-429638 → UHC-79488-43 (Ashley Brooks)
Member id
UHC-79488-43
Confidence
1
Method
probabilistic
MBR-006376CLM-429638
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003352
Orphan claim re-pointed
Claims processor
CLM-410209 → UHC-84878-58 (Sarah Edwards)
Member id
UHC-84878-58
Confidence
1
Method
probabilistic
MBR-021509CLM-410209
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003353
Orphan claim re-pointed
Claims processor
CLM-401846 → UHC-21471-68 (Ana Garcia)
Member id
UHC-21471-68
Confidence
1
Method
probabilistic
MBR-010880CLM-401846
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003354
Orphan claim re-pointed
Claims processor
CLM-410695 → UHC-77460-19 (Emily Anderson)
Member id
UHC-77460-19
Confidence
1
Method
probabilistic
MBR-001921CLM-410695
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003355
Orphan claim re-pointed
Claims processor
CLM-431993 → UHC-42321-42 (Sarah Long)
Member id
UHC-42321-42
Confidence
1
Method
probabilistic
MBR-012502CLM-431993
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003356
Orphan claim re-pointed
Claims processor
CLM-407351 → UHC-10303-10 (Nicholas Romero)
Member id
UHC-10303-10
Confidence
0.99
Method
probabilistic
MBR-022274CLM-407351
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003357
Orphan claim re-pointed
Claims processor
CLM-413984 → UHC-82124-92 (Rachel Smith)
Member id
UHC-82124-92
Confidence
1
Method
probabilistic
MBR-024195CLM-413984
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003358
Orphan claim re-pointed
Claims processor
CLM-425609 → UHC-84542-04 (Nicole Evans)
Member id
UHC-84542-04
Confidence
1
Method
probabilistic
MBR-033414CLM-425609
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003359
Orphan claim re-pointed
Claims processor
CLM-410789 → UHC-38202-11 (Deb McDonald)
Member id
UHC-38202-11
Confidence
1
Method
probabilistic
MBR-023928CLM-410789
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003360
Orphan claim re-pointed
Claims processor
CLM-416031 → UHC-87826-91 (Melissa Rodriguez)
Member id
UHC-87826-91
Confidence
1
Method
probabilistic
MBR-007318CLM-416031
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003361
Orphan claim re-pointed
Claims processor
CLM-418188 → UHC-96996-81 (Jennifer Powell)
Member id
UHC-96996-81
Confidence
1
Method
probabilistic
MBR-006519CLM-418188
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003362
Orphan claim re-pointed
Claims processor
CLM-423740 → UHC-32392-13 (Pmaela Berry)
Member id
UHC-32392-13
Confidence
0.99
Method
probabilistic
MBR-005785CLM-423740
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003363
Orphan claim re-pointed
Claims processor
CLM-411190 → UHC-33676-78 (Brandon Bennett)
Member id
UHC-33676-78
Confidence
0.99
Method
probabilistic
MBR-008565CLM-411190
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003364
Orphan claim re-pointed
Claims processor
CLM-412734 → UHC-44774-84 (Eugene Richardson)
Member id
UHC-44774-84
Confidence
1
Method
probabilistic
MBR-008997CLM-412734
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003365
Orphan claim re-pointed
Claims processor
CLM-407552 → UHC-56755-08 (Samantha Greene)
Member id
UHC-56755-08
Confidence
1
Method
probabilistic
MBR-037525CLM-407552
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003366
Orphan claim re-pointed
Claims processor
CLM-402602 → UHC-45508-66 (Thomas Cook)
Member id
UHC-45508-66
Confidence
1
Method
probabilistic
MBR-027413CLM-402602
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003367
Orphan claim re-pointed
Claims processor
CLM-422628 → UHC-25483-47 (Diane Simmons)
Member id
UHC-25483-47
Confidence
1
Method
probabilistic
MBR-041540CLM-422628
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003368
Orphan claim re-pointed
Claims processor
CLM-416621 → UHC-22905-01 (Wayne Bailey)
Member id
UHC-22905-01
Confidence
1
Method
probabilistic
MBR-003535CLM-416621
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003369
Orphan claim re-pointed
Claims processor
CLM-409971 → UHC-84539-43 (Dylan Foster)
Member id
UHC-84539-43
Confidence
1
Method
probabilistic
MBR-018096CLM-409971
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003370
Orphan claim re-pointed
Claims processor
CLM-425866 → UHC-28110-84 (Roger Gordon)
Member id
UHC-28110-84
Confidence
0.99
Method
probabilistic
MBR-011208CLM-425866
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003371
Orphan claim re-pointed
Claims processor
CLM-425605 → UHC-75343-29 (Lauren Wang)
Member id
UHC-75343-29
Confidence
1
Method
probabilistic
MBR-000146CLM-425605
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003372
Orphan claim re-pointed
Claims processor
CLM-404383 → UHC-06599-74 (Arthur Meyer)
Member id
UHC-06599-74
Confidence
1
Method
probabilistic
MBR-011200CLM-404383
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003373
Orphan claim re-pointed
Claims processor
CLM-404559 → UHC-45682-55 (David Daniels)
Member id
UHC-45682-55
Confidence
1
Method
probabilistic
MBR-003333CLM-404559
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003374
Orphan claim re-pointed
Claims processor
CLM-409901 → UHC-39979-07 (Scott Hart)
Member id
UHC-39979-07
Confidence
1
Method
probabilistic
MBR-001199CLM-409901
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003375
Orphan claim re-pointed
Claims processor
CLM-403359 → UHC-56158-59 (Jose Dixon)
Member id
UHC-56158-59
Confidence
0.97
Method
deterministic
MBR-035601CLM-403359
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003376
Orphan claim re-pointed
Claims processor
CLM-413689 → UHC-35596-29 (Anthony Palmer)
Member id
UHC-35596-29
Confidence
1
Method
probabilistic
MBR-024296CLM-413689
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003377
Orphan claim re-pointed
Claims processor
CLM-403323 → UHC-76050-53 (Luis Lucas)
Member id
UHC-76050-53
Confidence
0.99
Method
probabilistic
MBR-004247CLM-403323
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003378
Orphan claim re-pointed
Claims processor
CLM-402259 → UHC-45753-10 (Andrea Gonzles)
Member id
UHC-45753-10
Confidence
1.00
Method
probabilistic
MBR-022375CLM-402259
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003379
Orphan claim re-pointed
Claims processor
CLM-428042 → UHC-34443-43 (Austin Santos)
Member id
UHC-34443-43
Confidence
1
Method
probabilistic
MBR-002733CLM-428042
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003380
Orphan claim re-pointed
Claims processor
CLM-431039 → UHC-04560-91 (Madison Ortega)
Member id
UHC-04560-91
Confidence
0.86
Method
probabilistic
MBR-040368CLM-431039
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003381
Orphan claim re-pointed
Claims processor
CLM-417186 → UHC-87854-09 (Julia Jackson)
Member id
UHC-87854-09
Confidence
1
Method
probabilistic
MBR-009925CLM-417186
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003382
Orphan claim re-pointed
Claims processor
CLM-430816 → UHC-56570-23 (Diego Montgomery)
Member id
UHC-56570-23
Confidence
1
Method
probabilistic
MBR-002410CLM-430816
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003383
Orphan claim re-pointed
Claims processor
CLM-425254 → UHC-36645-75 (Sophia Hunt)
Member id
UHC-36645-75
Confidence
1
Method
probabilistic
MBR-005512CLM-425254
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003384
Orphan claim re-pointed
Claims processor
CLM-407307 → UHC-77213-11 (Rachel Watson)
Member id
UHC-77213-11
Confidence
1
Method
probabilistic
MBR-019966CLM-407307
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003385
Orphan claim re-pointed
Claims processor
CLM-418220 → UHC-37752-51 (Stephen Brown)
Member id
UHC-37752-51
Confidence
1
Method
probabilistic
MBR-019443CLM-418220
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003386
Orphan claim re-pointed
Claims processor
CLM-426778 → UHC-97344-04 (Roy Ellis)
Member id
UHC-97344-04
Confidence
0.99
Method
probabilistic
MBR-006427CLM-426778
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003387
Orphan claim re-pointed
Claims processor
CLM-412063 → UHC-76772-44 (Bradley Armstrong)
Member id
UHC-76772-44
Confidence
0.89
Method
probabilistic
MBR-010209CLM-412063
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003388
Orphan claim re-pointed
Claims processor
CLM-426520 → UHC-76289-79 (Kelly Robinson)
Member id
UHC-76289-79
Confidence
0.97
Method
deterministic
MBR-021425CLM-426520
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003389
Orphan claim re-pointed
Claims processor
CLM-406267 → UHC-11986-50 (Justin Moore)
Member id
UHC-11986-50
Confidence
1
Method
probabilistic
MBR-019840CLM-406267
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 41 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.