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-003440
Orphan claim re-pointed
Claims processor
CLM-431065 → UHC-26396-77 (Madison Johnson)
Member id
UHC-26396-77
Confidence
1
Method
probabilistic
MBR-015569CLM-431065
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003441
Orphan claim re-pointed
Claims processor
CLM-409008 → UHC-10689-03 (Jacqueline Williams)
Member id
UHC-10689-03
Confidence
1
Method
probabilistic
MBR-011346CLM-409008
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003442
Orphan claim re-pointed
Claims processor
CLM-431135 → UHC-57979-50 (Ahmed Castro)
Member id
UHC-57979-50
Confidence
1
Method
probabilistic
MBR-006023CLM-431135
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003443
Orphan claim re-pointed
Claims processor
CLM-410290 → UHC-03154-63 (Karen Morrison)
Member id
UHC-03154-63
Confidence
1
Method
probabilistic
MBR-032093CLM-410290
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003444
Orphan claim re-pointed
Claims processor
CLM-419619 → UHC-01304-13 (Virginia Weaver)
Member id
UHC-01304-13
Confidence
0.90
Method
probabilistic
MBR-000696CLM-419619
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003445
Orphan claim re-pointed
Claims processor
CLM-406860 → UHC-26327-53 (Green Luis)
Member id
UHC-26327-53
Confidence
1
Method
probabilistic
MBR-037942CLM-406860
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003446
Orphan claim re-pointed
Claims processor
CLM-426614 → UHC-01963-18 (Elizabeth Rodriguez)
Member id
UHC-01963-18
Confidence
1.00
Method
probabilistic
MBR-013764CLM-426614
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003447
Orphan claim re-pointed
Claims processor
CLM-402490 → UHC-98911-16 (Sandra Morris)
Member id
UHC-98911-16
Confidence
1
Method
probabilistic
MBR-033116CLM-402490
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003448
Orphan claim re-pointed
Claims processor
CLM-400263 → UHC-60296-67 (Madison Boyd)
Member id
UHC-60296-67
Confidence
1
Method
probabilistic
MBR-001110CLM-400263
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003449
Orphan claim re-pointed
Claims processor
CLM-429477 → UHC-23318-25 (Natalie Weber)
Member id
UHC-23318-25
Confidence
1
Method
probabilistic
MBR-004277CLM-429477
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003450
Orphan claim re-pointed
Claims processor
CLM-406025 → UHC-75871-12 (Jesse Fields)
Member id
UHC-75871-12
Confidence
1
Method
probabilistic
MBR-024212CLM-406025
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003451
Orphan claim re-pointed
Claims processor
CLM-403542 → UHC-74968-93 (Carol Carlson)
Member id
UHC-74968-93
Confidence
1
Method
probabilistic
MBR-008406CLM-403542
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003452
Orphan claim re-pointed
Claims processor
CLM-428067 → UHC-16244-46 (Jason Hunt)
Member id
UHC-16244-46
Confidence
0.97
Method
deterministic
MBR-029423CLM-428067
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003453
Orphan claim re-pointed
Claims processor
CLM-409985 → UHC-32190-08 (Danielle Parker)
Member id
UHC-32190-08
Confidence
1
Method
probabilistic
MBR-014114CLM-409985
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003454
Orphan claim re-pointed
Claims processor
CLM-400689 → UHC-15237-29 (Pamela Bradley)
Member id
UHC-15237-29
Confidence
0.97
Method
deterministic
MBR-003952CLM-400689
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003455
Orphan claim re-pointed
Claims processor
CLM-408606 → UHC-26295-65 (Jonathan Ward)
Member id
UHC-26295-65
Confidence
0.97
Method
deterministic
MBR-004947CLM-408606
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003456
Orphan claim re-pointed
Claims processor
CLM-428486 → UHC-96369-89 (Terry Hughes)
Member id
UHC-96369-89
Confidence
1
Method
probabilistic
MBR-033914CLM-428486
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003457
Orphan claim re-pointed
Claims processor
CLM-422174 → UHC-31199-52 (Sarah Phillips)
Member id
UHC-31199-52
Confidence
0.97
Method
deterministic
MBR-008019CLM-422174
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003458
Orphan claim re-pointed
Claims processor
CLM-426897 → UHC-90352-64 (Stephen Lawrence)
Member id
UHC-90352-64
Confidence
0.97
Method
deterministic
MBR-014290CLM-426897
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003459
Orphan claim re-pointed
Claims processor
CLM-426371 → UHC-96232-44 (Heather Pena)
Member id
UHC-96232-44
Confidence
1
Method
probabilistic
MBR-028567CLM-426371
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003460
Orphan claim re-pointed
Claims processor
CLM-422124 → UHC-31111-49 (Sara Estrada)
Member id
UHC-31111-49
Confidence
1
Method
probabilistic
MBR-025408CLM-422124
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003461
Orphan claim re-pointed
Claims processor
CLM-414810 → UHC-42231-04 (Kathryn Hall)
Member id
UHC-42231-04
Confidence
0.97
Method
deterministic
MBR-043585CLM-414810
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003462
Orphan claim re-pointed
Claims processor
CLM-412243 → UHC-40023-82 (Victoria Ross)
Member id
UHC-40023-82
Confidence
1
Method
probabilistic
MBR-007791CLM-412243
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003463
Orphan claim re-pointed
Claims processor
CLM-403698 → UHC-23547-97 (Park Jonathan)
Member id
UHC-23547-97
Confidence
0.98
Method
probabilistic
MBR-033791CLM-403698
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003464
Orphan claim re-pointed
Claims processor
CLM-431450 → UHC-31781-97 (Anna Weaver)
Member id
UHC-31781-97
Confidence
1
Method
probabilistic
MBR-015602CLM-431450
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003465
Orphan claim re-pointed
Claims processor
CLM-412057 → UHC-61845-14 (Hannah Sims)
Member id
UHC-61845-14
Confidence
1
Method
probabilistic
MBR-014579CLM-412057
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003466
Orphan claim re-pointed
Claims processor
CLM-410101 → UHC-71809-10 (Rebecca Schultz)
Member id
UHC-71809-10
Confidence
1
Method
probabilistic
MBR-033637CLM-410101
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003467
Orphan claim re-pointed
Claims processor
CLM-411518 → UHC-98692-59 (Peter Wong)
Member id
UHC-98692-59
Confidence
1
Method
probabilistic
MBR-018003CLM-411518
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003468
Orphan claim re-pointed
Claims processor
CLM-415178 → UHC-41067-77 (Frank Nelson)
Member id
UHC-41067-77
Confidence
0.97
Method
deterministic
MBR-018239CLM-415178
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003469
Orphan claim re-pointed
Claims processor
CLM-416589 → UHC-13389-59 (Christopher Stewart)
Member id
UHC-13389-59
Confidence
1
Method
probabilistic
MBR-012789CLM-416589
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003470
Orphan claim re-pointed
Claims processor
CLM-411932 → UHC-35659-03 (Ana Mejia)
Member id
UHC-35659-03
Confidence
1
Method
probabilistic
MBR-032859CLM-411932
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003471
Orphan claim re-pointed
Claims processor
CLM-414457 → UHC-13241-25 (Emma McDonald)
Member id
UHC-13241-25
Confidence
1
Method
probabilistic
MBR-041757CLM-414457
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003472
Orphan claim re-pointed
Claims processor
CLM-422725 → UHC-27129-15 (Gerald Arnold)
Member id
UHC-27129-15
Confidence
1
Method
probabilistic
MBR-032297CLM-422725
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003473
Orphan claim re-pointed
Claims processor
CLM-421266 → UHC-86167-37 (Christian Hayes)
Member id
UHC-86167-37
Confidence
1
Method
probabilistic
MBR-006805CLM-421266
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003474
Orphan claim re-pointed
Claims processor
CLM-427217 → UHC-66661-01 (Amanda Peters)
Member id
UHC-66661-01
Confidence
0.97
Method
deterministic
MBR-027439CLM-427217
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003475
Orphan claim re-pointed
Claims processor
CLM-429766 → UHC-93948-39 (Kathryn Fields)
Member id
UHC-93948-39
Confidence
0.97
Method
deterministic
MBR-040959CLM-429766
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003476
Orphan claim re-pointed
Claims processor
CLM-427168 → UHC-36711-03 (Doris Pierce)
Member id
UHC-36711-03
Confidence
0.97
Method
deterministic
MBR-012996CLM-427168
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003477
Orphan claim re-pointed
Claims processor
CLM-429246 → UHC-09503-37 (Stephanie Thomas)
Member id
UHC-09503-37
Confidence
1
Method
probabilistic
MBR-012617CLM-429246
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003478
Orphan claim re-pointed
Claims processor
CLM-406889 → UHC-96152-36 (Priya Cook)
Member id
UHC-96152-36
Confidence
1
Method
probabilistic
MBR-006563CLM-406889
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003479
Orphan claim re-pointed
Claims processor
CLM-407477 → UHC-63528-39 (Sara Reyes)
Member id
UHC-63528-39
Confidence
1
Method
probabilistic
MBR-020483CLM-407477
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003480
Orphan claim re-pointed
Claims processor
CLM-407909 → UHC-44850-78 (Michelle Lee)
Member id
UHC-44850-78
Confidence
1
Method
probabilistic
MBR-010206CLM-407909
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003481
Orphan claim re-pointed
Claims processor
CLM-427781 → UHC-33831-92 (Robert Bryant)
Member id
UHC-33831-92
Confidence
1
Method
probabilistic
MBR-003929CLM-427781
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003482
Orphan claim re-pointed
Claims processor
CLM-420664 → UHC-17753-40 (Scott Thomas)
Member id
UHC-17753-40
Confidence
0.98
Method
probabilistic
MBR-002585CLM-420664
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003483
Orphan claim re-pointed
Claims processor
CLM-410171 → UHC-74527-12 (Lauren Gutierrez)
Member id
UHC-74527-12
Confidence
1
Method
probabilistic
MBR-032797CLM-410171
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003484
Orphan claim re-pointed
Claims processor
CLM-410270 → UHC-15131-53 (Rebecca Elliott)
Member id
UHC-15131-53
Confidence
1
Method
probabilistic
MBR-002956CLM-410270
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003485
Orphan claim re-pointed
Claims processor
CLM-419105 → UHC-65879-07 (Gregory Reid)
Member id
UHC-65879-07
Confidence
0.98
Method
probabilistic
MBR-001792CLM-419105
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003486
Orphan claim re-pointed
Claims processor
CLM-423465 → UHC-07211-06 (Amber Willis)
Member id
UHC-07211-06
Confidence
1
Method
probabilistic
MBR-011183CLM-423465
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003487
Orphan claim re-pointed
Claims processor
CLM-409419 → UHC-38119-75 (Robert Edwards)
Member id
UHC-38119-75
Confidence
1
Method
probabilistic
MBR-038818CLM-409419
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003488
Orphan claim re-pointed
Claims processor
CLM-414870 → UHC-18183-88 (Dorothy Hudson)
Member id
UHC-18183-88
Confidence
1
Method
probabilistic
MBR-000565CLM-414870
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003489
Orphan claim re-pointed
Claims processor
CLM-416751 → UHC-71644-16 (Omar Hicks)
Member id
UHC-71644-16
Confidence
0.98
Method
probabilistic
MBR-013816CLM-416751
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 43 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.