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-003490
Orphan claim re-pointed
Claims processor
CLM-431813 → UHC-08132-83 (Alexis McCoy)
Member id
UHC-08132-83
Confidence
1
Method
probabilistic
MBR-018059CLM-431813
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003491
Orphan claim re-pointed
Claims processor
CLM-407801 → UHC-48704-64 (Eric Lane)
Member id
UHC-48704-64
Confidence
1
Method
probabilistic
MBR-013336CLM-407801
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003492
Orphan claim re-pointed
Claims processor
CLM-429675 → UHC-32037-03 (Rachel Baker)
Member id
UHC-32037-03
Confidence
1
Method
probabilistic
MBR-002200CLM-429675
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003493
Orphan claim re-pointed
Claims processor
CLM-405418 → UHC-21603-47 (Roger Carroll)
Member id
UHC-21603-47
Confidence
1
Method
probabilistic
MBR-015528CLM-405418
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003494
Orphan claim re-pointed
Claims processor
CLM-413892 → UHC-86816-93 (Aisha Moore)
Member id
UHC-86816-93
Confidence
0.97
Method
deterministic
MBR-038697CLM-413892
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003495
Orphan claim re-pointed
Claims processor
CLM-424453 → UHC-24245-99 (Austin Rose)
Member id
UHC-24245-99
Confidence
0.97
Method
deterministic
MBR-005601CLM-424453
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003496
Orphan claim re-pointed
Claims processor
CLM-431036 → UHC-15465-68 (Emily Ford)
Member id
UHC-15465-68
Confidence
1
Method
probabilistic
MBR-014738CLM-431036
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003497
Orphan claim re-pointed
Claims processor
CLM-418750 → UHC-02927-16 (Saamuel Chavez)
Member id
UHC-02927-16
Confidence
0.97
Method
deterministic
MBR-012380CLM-418750
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003498
Orphan claim re-pointed
Claims processor
CLM-404285 → UHC-48762-31 (Helen McCoy)
Member id
UHC-48762-31
Confidence
0.94
Method
probabilistic
MBR-042923CLM-404285
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003499
Orphan claim re-pointed
Claims processor
CLM-427765 → UHC-93261-88 (Anthony Harris)
Member id
UHC-93261-88
Confidence
1
Method
probabilistic
MBR-025039CLM-427765
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003500
Orphan claim re-pointed
Claims processor
CLM-410765 → UHC-05869-27 (Brittany Fowler)
Member id
UHC-05869-27
Confidence
1
Method
probabilistic
MBR-017462CLM-410765
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003501
Orphan claim re-pointed
Claims processor
CLM-425817 → UHC-57021-61 (Christine Wagner)
Member id
UHC-57021-61
Confidence
1
Method
probabilistic
MBR-007869CLM-425817
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003502
Orphan claim re-pointed
Claims processor
CLM-416519 → UHC-24158-50 (Billy Jackson)
Member id
UHC-24158-50
Confidence
1
Method
probabilistic
MBR-035617CLM-416519
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003503
Orphan claim re-pointed
Claims processor
CLM-425139 → UHC-19058-33 (Logan Davis)
Member id
UHC-19058-33
Confidence
1
Method
probabilistic
MBR-018885CLM-425139
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003504
Orphan claim re-pointed
Claims processor
CLM-431581 → UHC-38179-85 (Sarah Cook)
Member id
UHC-38179-85
Confidence
0.97
Method
deterministic
MBR-018351CLM-431581
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003505
Orphan claim re-pointed
Claims processor
CLM-421258 → UHC-61130-89 (Dorothy Bradley)
Member id
UHC-61130-89
Confidence
1
Method
probabilistic
MBR-001864CLM-421258
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003506
Orphan claim re-pointed
Claims processor
CLM-423999 → UHC-92254-86 (Frank Richards)
Member id
UHC-92254-86
Confidence
1
Method
probabilistic
MBR-004071CLM-423999
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003507
Orphan claim re-pointed
Claims processor
CLM-400067 → UHC-78966-48 (Lawrence Kelly)
Member id
UHC-78966-48
Confidence
1
Method
probabilistic
MBR-027677CLM-400067
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003508
Orphan claim re-pointed
Claims processor
CLM-407789 → UHC-11426-40 (Kenneth Palmer)
Member id
UHC-11426-40
Confidence
0.97
Method
deterministic
MBR-011388CLM-407789
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003509
Orphan claim re-pointed
Claims processor
CLM-405403 → UHC-53023-13 (Jerry Franklin)
Member id
UHC-53023-13
Confidence
1
Method
probabilistic
MBR-015656CLM-405403
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003510
Orphan claim re-pointed
Claims processor
CLM-408225 → UHC-24001-25 (Sandra Ryan)
Member id
UHC-24001-25
Confidence
1
Method
probabilistic
MBR-035151CLM-408225
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003511
Orphan claim re-pointed
Claims processor
CLM-422142 → UHC-88614-34 (Joan Edwards)
Member id
UHC-88614-34
Confidence
1
Method
probabilistic
MBR-008807CLM-422142
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003512
Orphan claim re-pointed
Claims processor
CLM-417829 → UHC-66935-98 (Ashley Bradley)
Member id
UHC-66935-98
Confidence
1
Method
probabilistic
MBR-000890CLM-417829
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003513
Orphan claim re-pointed
Claims processor
CLM-422880 → UHC-10931-15 (Jonathan Kelly)
Member id
UHC-10931-15
Confidence
0.98
Method
probabilistic
MBR-010588CLM-422880
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003514
Orphan claim re-pointed
Claims processor
CLM-405592 → UHC-39876-62 (Rachel Hansen)
Member id
UHC-39876-62
Confidence
0.97
Method
deterministic
MBR-003154CLM-405592
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003515
Orphan claim re-pointed
Claims processor
CLM-406575 → UHC-26825-50 (Justin Cooper)
Member id
UHC-26825-50
Confidence
1
Method
probabilistic
MBR-033265CLM-406575
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003516
Orphan claim re-pointed
Claims processor
CLM-413953 → UHC-28639-46 (Joyce Reyes)
Member id
UHC-28639-46
Confidence
1
Method
probabilistic
MBR-004865CLM-413953
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003517
Orphan claim re-pointed
Claims processor
CLM-416087 → UHC-07850-72 (Sean Walsh)
Member id
UHC-07850-72
Confidence
0.99
Method
probabilistic
MBR-026106CLM-416087
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003518
Orphan claim re-pointed
Claims processor
CLM-415753 → UHC-27869-19 (Christine Roberts)
Member id
UHC-27869-19
Confidence
0.97
Method
deterministic
MBR-006341CLM-415753
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003519
Orphan claim re-pointed
Claims processor
CLM-416318 → UHC-69287-28 (Samantha Graham)
Member id
UHC-69287-28
Confidence
0.98
Method
probabilistic
MBR-026020CLM-416318
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003520
Orphan claim re-pointed
Claims processor
CLM-431265 → UHC-95083-87 (Thomas Luna)
Member id
UHC-95083-87
Confidence
0.97
Method
deterministic
MBR-026596CLM-431265
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003521
Orphan claim re-pointed
Claims processor
CLM-406217 → UHC-73728-14 (Frank Armstrong)
Member id
UHC-73728-14
Confidence
0.97
Method
deterministic
MBR-008805CLM-406217
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003522
Orphan claim re-pointed
Claims processor
CLM-430361 → UHC-39140-72 (Mariana Garrett)
Member id
UHC-39140-72
Confidence
1
Method
probabilistic
MBR-021874CLM-430361
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003523
Orphan claim re-pointed
Claims processor
CLM-401388 → UHC-99603-38 (Scott Evans)
Member id
UHC-99603-38
Confidence
1
Method
probabilistic
MBR-004413CLM-401388
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003524
Orphan claim re-pointed
Claims processor
CLM-414750 → UHC-13601-93 (Juan Lopez)
Member id
UHC-13601-93
Confidence
1
Method
probabilistic
MBR-012669CLM-414750
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003525
Orphan claim re-pointed
Claims processor
CLM-404595 → UHC-13136-66 (Amber Mejia)
Member id
UHC-13136-66
Confidence
1
Method
probabilistic
MBR-017053CLM-404595
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003526
Orphan claim re-pointed
Claims processor
CLM-416843 → UHC-80412-20 (Aaron Castillo)
Member id
UHC-80412-20
Confidence
1
Method
probabilistic
MBR-004849CLM-416843
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003527
Orphan claim re-pointed
Claims processor
CLM-421944 → UHC-83412-14 (Douglas Soto)
Member id
UHC-83412-14
Confidence
0.97
Method
deterministic
MBR-018826CLM-421944
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003528
Orphan claim re-pointed
Claims processor
CLM-419114 → UHC-74605-10 (Graace Mendez)
Member id
UHC-74605-10
Confidence
0.97
Method
deterministic
MBR-020114CLM-419114
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003529
Orphan claim re-pointed
Claims processor
CLM-420909 → UHC-05548-92 (Michelle Carpenter)
Member id
UHC-05548-92
Confidence
1
Method
probabilistic
MBR-002812CLM-420909
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003530
Orphan claim re-pointed
Claims processor
CLM-405824 → UHC-73667-01 (Carolyn Luna)
Member id
UHC-73667-01
Confidence
0.93
Method
probabilistic
MBR-035552CLM-405824
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003531
Orphan claim re-pointed
Claims processor
CLM-424093 → UHC-37073-66 (Nicole Gonzalez)
Member id
UHC-37073-66
Confidence
1
Method
probabilistic
MBR-003217CLM-424093
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003532
Orphan claim re-pointed
Claims processor
CLM-402569 → UHC-53180-13 (Andrew Cox)
Member id
UHC-53180-13
Confidence
1
Method
probabilistic
MBR-008357CLM-402569
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003533
Orphan claim re-pointed
Claims processor
CLM-425065 → UHC-66989-30 (Terry Watson)
Member id
UHC-66989-30
Confidence
1
Method
probabilistic
MBR-008594CLM-425065
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003534
Orphan claim re-pointed
Claims processor
CLM-430223 → UHC-85289-63 (Jaince Hawkins)
Member id
UHC-85289-63
Confidence
0.97
Method
deterministic
MBR-020326CLM-430223
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003535
Orphan claim re-pointed
Claims processor
CLM-400216 → UHC-17817-28 (Harold Pena)
Member id
UHC-17817-28
Confidence
1
Method
probabilistic
MBR-011646CLM-400216
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003536
Orphan claim re-pointed
Claims processor
CLM-414916 → UHC-32027-99 (Andrea Pena)
Member id
UHC-32027-99
Confidence
0.97
Method
deterministic
MBR-014932CLM-414916
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003537
Orphan claim re-pointed
Claims processor
CLM-407026 → UHC-68285-69 (Andrew Woods)
Member id
UHC-68285-69
Confidence
0.97
Method
deterministic
MBR-012569CLM-407026
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003538
Orphan claim re-pointed
Claims processor
CLM-415122 → UHC-96249-54 (Timothy Brooks)
Member id
UHC-96249-54
Confidence
1
Method
probabilistic
MBR-015364CLM-415122
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003539
Orphan claim re-pointed
Claims processor
CLM-427410 → UHC-82962-29 (Gloria Ward)
Member id
UHC-82962-29
Confidence
1
Method
probabilistic
MBR-001887CLM-427410
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 44 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.