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-003540
Orphan claim re-pointed
Claims processor
CLM-419531 → UHC-22772-73 (Jessica Young)
Member id
UHC-22772-73
Confidence
0.97
Method
deterministic
MBR-027179CLM-419531
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003541
Orphan claim re-pointed
Claims processor
CLM-431370 → UHC-41025-03 (William Collins)
Member id
UHC-41025-03
Confidence
1
Method
probabilistic
MBR-030469CLM-431370
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003542
Orphan claim re-pointed
Claims processor
CLM-422721 → UHC-44775-27 (Roger Ortega)
Member id
UHC-44775-27
Confidence
1
Method
probabilistic
MBR-011479CLM-422721
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003543
Orphan claim re-pointed
Claims processor
CLM-410587 → UHC-39136-20 (Judy Franklin)
Member id
UHC-39136-20
Confidence
0.97
Method
deterministic
MBR-006698CLM-410587
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003544
Orphan claim re-pointed
Claims processor
CLM-410102 → UHC-71809-10 (Rebecca Schultz)
Member id
UHC-71809-10
Confidence
1
Method
probabilistic
MBR-033637CLM-410102
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003545
Orphan claim re-pointed
Claims processor
CLM-403518 → UHC-82338-95 (Luis Richards)
Member id
UHC-82338-95
Confidence
0.85
Method
probabilistic
MBR-006861CLM-403518
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003546
Orphan claim re-pointed
Claims processor
CLM-411645 → UHC-09877-57 (Jonathan Ortega)
Member id
UHC-09877-57
Confidence
1
Method
probabilistic
MBR-012716CLM-411645
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003547
Orphan claim re-pointed
Claims processor
CLM-422691 → UHC-26774-18 (Richard Santiago)
Member id
UHC-26774-18
Confidence
0.97
Method
deterministic
MBR-000123CLM-422691
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003548
Orphan claim re-pointed
Claims processor
CLM-400821 → UHC-65216-04 (Albert Hanson)
Member id
UHC-65216-04
Confidence
1
Method
probabilistic
MBR-028200CLM-400821
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003549
Orphan claim re-pointed
Claims processor
CLM-405704 → UHC-77190-83 (Abigail Little)
Member id
UHC-77190-83
Confidence
1
Method
probabilistic
MBR-019965CLM-405704
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003550
Orphan claim re-pointed
Claims processor
CLM-420287 → UHC-61742-56 (Kevin Mejia)
Member id
UHC-61742-56
Confidence
0.97
Method
deterministic
MBR-029027CLM-420287
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003551
Orphan claim re-pointed
Claims processor
CLM-400660 → UHC-86290-04 (Ashley Brown)
Member id
UHC-86290-04
Confidence
1
Method
probabilistic
MBR-005313CLM-400660
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003552
Orphan claim re-pointed
Claims processor
CLM-403654 → UHC-42261-80 (Kyle Salazar)
Member id
UHC-42261-80
Confidence
1
Method
probabilistic
MBR-024001CLM-403654
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003553
Orphan claim re-pointed
Claims processor
CLM-403065 → UHC-59619-27 (Terry Lane)
Member id
UHC-59619-27
Confidence
1
Method
probabilistic
MBR-027420CLM-403065
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003554
Orphan claim re-pointed
Claims processor
CLM-417229 → UHC-88955-23 (Andrea Anderson)
Member id
UHC-88955-23
Confidence
1
Method
probabilistic
MBR-018844CLM-417229
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003555
Orphan claim re-pointed
Claims processor
CLM-417802 → UHC-50434-74 (Gloria Crawford)
Member id
UHC-50434-74
Confidence
1
Method
probabilistic
MBR-020240CLM-417802
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003556
Orphan claim re-pointed
Claims processor
CLM-426640 → UHC-70984-66 (Kelly Lawrence)
Member id
UHC-70984-66
Confidence
0.97
Method
deterministic
MBR-018474CLM-426640
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003557
Orphan claim re-pointed
Claims processor
CLM-419945 → UHC-60747-77 (Robert Price)
Member id
UHC-60747-77
Confidence
0.97
Method
deterministic
MBR-002869CLM-419945
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003558
Orphan claim re-pointed
Claims processor
CLM-428108 → UHC-55649-52 (Daniels Arjun)
Member id
UHC-55649-52
Confidence
0.98
Method
probabilistic
MBR-040633CLM-428108
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003559
Orphan claim re-pointed
Claims processor
CLM-413271 → UHC-96133-18 (Grace Maldonado)
Member id
UHC-96133-18
Confidence
0.97
Method
deterministic
MBR-019571CLM-413271
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003560
Orphan claim re-pointed
Claims processor
CLM-431682 → UHC-20252-42 (Terry Boyd)
Member id
UHC-20252-42
Confidence
0.97
Method
deterministic
MBR-025417CLM-431682
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003561
Orphan claim re-pointed
Claims processor
CLM-426797 → UHC-60300-25 (Cheryl Walker)
Member id
UHC-60300-25
Confidence
0.97
Method
deterministic
MBR-024753CLM-426797
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003562
Orphan claim re-pointed
Claims processor
CLM-412128 → UHC-77128-20 (Ruth Rose)
Member id
UHC-77128-20
Confidence
0.97
Method
deterministic
MBR-000984CLM-412128
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003563
Orphan claim re-pointed
Claims processor
CLM-402443 → UHC-50096-50 (Josh Turner)
Member id
UHC-50096-50
Confidence
0.99
Method
probabilistic
MBR-023145CLM-402443
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003564
Orphan claim re-pointed
Claims processor
CLM-410596 → UHC-37511-88 (Marcus Pierce)
Member id
UHC-37511-88
Confidence
1
Method
probabilistic
MBR-004047CLM-410596
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003565
Orphan claim re-pointed
Claims processor
CLM-420980 → UHC-63371-59 (Andrew Fernandez)
Member id
UHC-63371-59
Confidence
1
Method
probabilistic
MBR-033159CLM-420980
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003566
Orphan claim re-pointed
Claims processor
CLM-402752 → UHC-48982-35 (Charlotte Henderson)
Member id
UHC-48982-35
Confidence
0.97
Method
deterministic
MBR-039156CLM-402752
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003567
Orphan claim re-pointed
Claims processor
CLM-422853 → UHC-87121-87 (Julia Baker)
Member id
UHC-87121-87
Confidence
1
Method
probabilistic
MBR-000122CLM-422853
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003568
Orphan claim re-pointed
Claims processor
CLM-402568 → UHC-48696-50 (Mateo Jackson)
Member id
UHC-48696-50
Confidence
1
Method
probabilistic
MBR-000500CLM-402568
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003569
Orphan claim re-pointed
Claims processor
CLM-432311 → UHC-35129-23 (Ashley Silva)
Member id
UHC-35129-23
Confidence
1
Method
probabilistic
MBR-033944CLM-432311
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003570
Orphan claim re-pointed
Claims processor
CLM-424780 → UHC-73125-87 (Gabriel Patterson)
Member id
UHC-73125-87
Confidence
1
Method
probabilistic
MBR-007631CLM-424780
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003571
Orphan claim re-pointed
Claims processor
CLM-429399 → UHC-04988-64 (Theresa Carter)
Member id
UHC-04988-64
Confidence
1
Method
probabilistic
MBR-008392CLM-429399
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003572
Orphan claim re-pointed
Claims processor
CLM-402262 → UHC-43857-58 (Sofia Day)
Member id
UHC-43857-58
Confidence
1
Method
probabilistic
MBR-003545CLM-402262
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003573
Orphan claim re-pointed
Claims processor
CLM-406803 → UHC-22406-82 (Jacob King)
Member id
UHC-22406-82
Confidence
1
Method
probabilistic
MBR-001075CLM-406803
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003574
Orphan claim re-pointed
Claims processor
CLM-429798 → UHC-88610-44 (Sandra Hart)
Member id
UHC-88610-44
Confidence
1
Method
probabilistic
MBR-004045CLM-429798
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003575
Orphan claim re-pointed
Claims processor
CLM-405208 → UHC-38844-27 (Charlotte Delgado)
Member id
UHC-38844-27
Confidence
1
Method
probabilistic
MBR-039128CLM-405208
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003576
Orphan claim re-pointed
Claims processor
CLM-414863 → UHC-49725-20 (Gloriia Ramirez)
Member id
UHC-49725-20
Confidence
0.97
Method
deterministic
MBR-043234CLM-414863
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003577
Orphan claim re-pointed
Claims processor
CLM-432371 → UHC-01616-25 (Deborah Mason)
Member id
UHC-01616-25
Confidence
0.86
Method
probabilistic
MBR-040479CLM-432371
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003578
Orphan claim re-pointed
Claims processor
CLM-401737 → UHC-23813-69 (John Gardner)
Member id
UHC-23813-69
Confidence
1
Method
probabilistic
MBR-022166CLM-401737
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003579
Orphan claim re-pointed
Claims processor
CLM-428847 → UHC-37940-69 (Kelly Contreras)
Member id
UHC-37940-69
Confidence
1
Method
probabilistic
MBR-003464CLM-428847
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003580
Orphan claim re-pointed
Claims processor
CLM-402486 → UHC-09549-37 (Brittany Wright)
Member id
UHC-09549-37
Confidence
0.97
Method
deterministic
MBR-006597CLM-402486
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003581
Orphan claim re-pointed
Claims processor
CLM-417914 → UHC-78083-57 (Judith West)
Member id
UHC-78083-57
Confidence
1
Method
probabilistic
MBR-012031CLM-417914
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003582
Orphan claim re-pointed
Claims processor
CLM-417115 → UHC-39302-26 (Julia Morales)
Member id
UHC-39302-26
Confidence
1
Method
probabilistic
MBR-009465CLM-417115
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003583
Orphan claim re-pointed
Claims processor
CLM-409948 → UHC-02793-47 (Mariana Jones)
Member id
UHC-02793-47
Confidence
0.97
Method
deterministic
MBR-023903CLM-409948
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003584
Orphan claim re-pointed
Claims processor
CLM-414675 → UHC-72940-64 (Sophia Sandoval)
Member id
UHC-72940-64
Confidence
1
Method
probabilistic
MBR-014457CLM-414675
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003585
Orphan claim re-pointed
Claims processor
CLM-421378 → UHC-70202-76 (Dylan Bowman)
Member id
UHC-70202-76
Confidence
1
Method
probabilistic
MBR-020558CLM-421378
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003586
Orphan claim re-pointed
Claims processor
CLM-412256 → UHC-96793-99 (Jacob Chen)
Member id
UHC-96793-99
Confidence
1
Method
probabilistic
MBR-019844CLM-412256
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003587
Orphan claim re-pointed
Claims processor
CLM-427983 → UHC-06532-92 (Abigail Rios)
Member id
UHC-06532-92
Confidence
1
Method
probabilistic
MBR-015346CLM-427983
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003588
Orphan claim re-pointed
Claims processor
CLM-432700 → UHC-63213-69 (Rebecca Salazar)
Member id
UHC-63213-69
Confidence
1
Method
probabilistic
MBR-010589CLM-432700
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003589
Orphan claim re-pointed
Claims processor
CLM-431673 → UHC-97988-09 (Jacqueline Singh)
Member id
UHC-97988-09
Confidence
1
Method
probabilistic
MBR-022760CLM-431673
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 45 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.