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-003590
Orphan claim re-pointed
Claims processor
CLM-431051 → UHC-73405-81 (Andrew Dean)
Member id
UHC-73405-81
Confidence
1
Method
probabilistic
MBR-008245CLM-431051
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003591
Orphan claim re-pointed
Claims processor
CLM-403731 → UHC-53980-36 (Jessica Alexander)
Member id
UHC-53980-36
Confidence
0.97
Method
deterministic
MBR-019981CLM-403731
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003592
Orphan claim re-pointed
Claims processor
CLM-431736 → UHC-18114-77 (Arthur Valdez)
Member id
UHC-18114-77
Confidence
1
Method
probabilistic
MBR-022227CLM-431736
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003593
Orphan claim re-pointed
Claims processor
CLM-406057 → UHC-64556-29 (Zachary Hudson)
Member id
UHC-64556-29
Confidence
1
Method
probabilistic
MBR-022495CLM-406057
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003594
Orphan claim re-pointed
Claims processor
CLM-412118 → UHC-38053-93 (Aaron Daniels)
Member id
UHC-38053-93
Confidence
0.97
Method
deterministic
MBR-027501CLM-412118
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003595
Orphan claim re-pointed
Claims processor
CLM-420326 → UHC-58353-57 (Drew Matthews)
Member id
UHC-58353-57
Confidence
1
Method
probabilistic
MBR-005573CLM-420326
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003596
Orphan claim re-pointed
Claims processor
CLM-420960 → UHC-52307-49 (William Freeman)
Member id
UHC-52307-49
Confidence
0.93
Method
probabilistic
MBR-001574CLM-420960
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003597
Orphan claim re-pointed
Claims processor
CLM-401901 → UHC-39209-26 (Samuel Burns)
Member id
UHC-39209-26
Confidence
1
Method
probabilistic
MBR-009279CLM-401901
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003598
Orphan claim re-pointed
Claims processor
CLM-421045 → UHC-99344-22 (Joshua Williamson)
Member id
UHC-99344-22
Confidence
1
Method
probabilistic
MBR-031543CLM-421045
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003599
Orphan claim re-pointed
Claims processor
CLM-401740 → UHC-00302-33 (Teresa Hanson)
Member id
UHC-00302-33
Confidence
0.99
Method
probabilistic
MBR-012950CLM-401740
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003600
Orphan claim re-pointed
Claims processor
CLM-424552 → UHC-69765-55 (Blily Larson)
Member id
UHC-69765-55
Confidence
0.97
Method
deterministic
MBR-019186CLM-424552
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003601
Orphan claim re-pointed
Claims processor
CLM-426494 → UHC-80724-56 (Amanda McDonald)
Member id
UHC-80724-56
Confidence
1
Method
probabilistic
MBR-020672CLM-426494
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003602
Orphan claim re-pointed
Claims processor
CLM-404151 → UHC-49265-38 (Paul Crawford)
Member id
UHC-49265-38
Confidence
0.97
Method
deterministic
MBR-020854CLM-404151
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003603
Orphan claim re-pointed
Claims processor
CLM-428999 → UHC-30649-64 (Mason Perkins)
Member id
UHC-30649-64
Confidence
0.97
Method
deterministic
MBR-034010CLM-428999
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003604
Orphan claim re-pointed
Claims processor
CLM-414183 → UHC-78903-55 (Emma Hudson)
Member id
UHC-78903-55
Confidence
0.85
Method
probabilistic
MBR-007372CLM-414183
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003605
Orphan claim re-pointed
Claims processor
CLM-421649 → UHC-53180-18 (Mark Washington)
Member id
UHC-53180-18
Confidence
0.99
Method
probabilistic
MBR-004115CLM-421649
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003606
Orphan claim re-pointed
Claims processor
CLM-406352 → UHC-40218-11 (Angela Lawson)
Member id
UHC-40218-11
Confidence
1
Method
probabilistic
MBR-000667CLM-406352
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003607
Orphan claim re-pointed
Claims processor
CLM-426142 → UHC-74179-83 (Terry Burns)
Member id
UHC-74179-83
Confidence
1
Method
probabilistic
MBR-010690CLM-426142
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003608
Orphan claim re-pointed
Claims processor
CLM-403905 → UHC-12107-12 (Ralph Martin)
Member id
UHC-12107-12
Confidence
1
Method
probabilistic
MBR-024812CLM-403905
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003609
Orphan claim re-pointed
Claims processor
CLM-429715 → UHC-38570-43 (Gloria Martin)
Member id
UHC-38570-43
Confidence
1.00
Method
probabilistic
MBR-004710CLM-429715
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003610
Orphan claim re-pointed
Claims processor
CLM-421533 → UHC-20155-17 (Gregory Willis)
Member id
UHC-20155-17
Confidence
1
Method
probabilistic
MBR-019222CLM-421533
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003611
Orphan claim re-pointed
Claims processor
CLM-409291 → UHC-43144-61 (Benjamin Moreno)
Member id
UHC-43144-61
Confidence
1.00
Method
probabilistic
MBR-003895CLM-409291
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003612
Orphan claim re-pointed
Claims processor
CLM-413891 → UHC-98772-34 (Julia Cunningham)
Member id
UHC-98772-34
Confidence
1
Method
probabilistic
MBR-018814CLM-413891
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003613
Orphan claim re-pointed
Claims processor
CLM-417734 → UHC-17167-67 (Wayne Garza)
Member id
UHC-17167-67
Confidence
1
Method
probabilistic
MBR-002008CLM-417734
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003614
Orphan claim re-pointed
Claims processor
CLM-417552 → UHC-10019-54 (Albert Cruz)
Member id
UHC-10019-54
Confidence
0.86
Method
probabilistic
MBR-023958CLM-417552
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003615
Orphan claim re-pointed
Claims processor
CLM-428511 → UHC-54516-18 (Hannah Nelson)
Member id
UHC-54516-18
Confidence
1
Method
probabilistic
MBR-002099CLM-428511
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003616
Orphan claim re-pointed
Claims processor
CLM-406695 → UHC-65859-51 (Deborah Reyes)
Member id
UHC-65859-51
Confidence
1
Method
probabilistic
MBR-021494CLM-406695
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003617
Orphan claim re-pointed
Claims processor
CLM-403150 → UHC-95688-46 (Diego Jones)
Member id
UHC-95688-46
Confidence
0.97
Method
deterministic
MBR-019542CLM-403150
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003618
Orphan claim re-pointed
Claims processor
CLM-414917 → UHC-86231-01 (Christina Wilson)
Member id
UHC-86231-01
Confidence
1
Method
probabilistic
MBR-026654CLM-414917
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003619
Orphan claim re-pointed
Claims processor
CLM-421162 → UHC-43377-08 (Teresa Harrison)
Member id
UHC-43377-08
Confidence
0.97
Method
deterministic
MBR-010702CLM-421162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003620
Orphan claim re-pointed
Claims processor
CLM-422214 → UHC-15396-79 (Diana Spencer)
Member id
UHC-15396-79
Confidence
1
Method
probabilistic
MBR-009491CLM-422214
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003621
Orphan claim re-pointed
Claims processor
CLM-420944 → UHC-91116-58 (Russell Bell)
Member id
UHC-91116-58
Confidence
1
Method
probabilistic
MBR-008996CLM-420944
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003622
Orphan claim re-pointed
Claims processor
CLM-429647 → UHC-45864-37 (Kenneth Cox)
Member id
UHC-45864-37
Confidence
1.00
Method
probabilistic
MBR-009973CLM-429647
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003623
Orphan claim re-pointed
Claims processor
CLM-416853 → UHC-75899-09 (Jean Collins)
Member id
UHC-75899-09
Confidence
0.97
Method
deterministic
MBR-003447CLM-416853
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003624
Orphan claim re-pointed
Claims processor
CLM-413923 → UHC-11042-41 (Anthony Silva)
Member id
UHC-11042-41
Confidence
0.97
Method
deterministic
MBR-039778CLM-413923
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003625
Orphan claim re-pointed
Claims processor
CLM-415218 → UHC-44164-95 (Richard Johnson)
Member id
UHC-44164-95
Confidence
1
Method
probabilistic
MBR-002896CLM-415218
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003626
Orphan claim re-pointed
Claims processor
CLM-421090 → UHC-58798-14 (David Butler)
Member id
UHC-58798-14
Confidence
0.99
Method
probabilistic
MBR-005597CLM-421090
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003627
Orphan claim re-pointed
Claims processor
CLM-411404 → UHC-39812-09 (Emma Harrison)
Member id
UHC-39812-09
Confidence
1
Method
probabilistic
MBR-002130CLM-411404
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003628
Orphan claim re-pointed
Claims processor
CLM-430629 → UHC-77280-77 (Barbara Stevens)
Member id
UHC-77280-77
Confidence
1
Method
probabilistic
MBR-033963CLM-430629
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003629
Orphan claim re-pointed
Claims processor
CLM-404689 → UHC-45993-85 (Ashley Bowman)
Member id
UHC-45993-85
Confidence
1
Method
probabilistic
MBR-006306CLM-404689
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003630
Orphan claim re-pointed
Claims processor
CLM-431154 → UHC-80704-58 (Patrick Rios)
Member id
UHC-80704-58
Confidence
0.97
Method
deterministic
MBR-003721CLM-431154
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003631
Orphan claim re-pointed
Claims processor
CLM-430248 → UHC-10245-84 (Russell Matthews)
Member id
UHC-10245-84
Confidence
0.97
Method
deterministic
MBR-026283CLM-430248
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003632
Orphan claim re-pointed
Claims processor
CLM-421460 → UHC-10409-87 (Samantha Ray)
Member id
UHC-10409-87
Confidence
1
Method
probabilistic
MBR-003854CLM-421460
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003633
Orphan claim re-pointed
Claims processor
CLM-403986 → UHC-32919-73 (Jennifer Schmidt)
Member id
UHC-32919-73
Confidence
1
Method
probabilistic
MBR-028449CLM-403986
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003634
Orphan claim re-pointed
Claims processor
CLM-429182 → UHC-31006-11 (Megan Richardson)
Member id
UHC-31006-11
Confidence
0.97
Method
deterministic
MBR-020039CLM-429182
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003635
Orphan claim re-pointed
Claims processor
CLM-404973 → UHC-95807-32 (Aaron Mendez)
Member id
UHC-95807-32
Confidence
1
Method
probabilistic
MBR-015318CLM-404973
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003636
Orphan claim re-pointed
Claims processor
CLM-414187 → UHC-16639-21 (Sarah Bennett)
Member id
UHC-16639-21
Confidence
1
Method
probabilistic
MBR-018629CLM-414187
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003637
Orphan claim re-pointed
Claims processor
CLM-413459 → UHC-86002-96 (Jason Johnston)
Member id
UHC-86002-96
Confidence
1
Method
probabilistic
MBR-018090CLM-413459
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003638
Orphan claim re-pointed
Claims processor
CLM-430963 → UHC-19301-15 (Luis Butler)
Member id
UHC-19301-15
Confidence
0.97
Method
deterministic
MBR-017198CLM-430963
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003639
Orphan claim re-pointed
Claims processor
CLM-406708 → UHC-09499-92 (Mariana Ortega)
Member id
UHC-09499-92
Confidence
0.97
Method
deterministic
MBR-019202CLM-406708
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 46 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.