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-003740
Orphan claim re-pointed
Claims processor
CLM-430989 → UHC-34794-63 (Dennis Kelley)
Member id
UHC-34794-63
Confidence
1
Method
probabilistic
MBR-010834CLM-430989
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003741
Orphan claim re-pointed
Claims processor
CLM-422524 → UHC-80393-05 (Sofia Hicks)
Member id
UHC-80393-05
Confidence
0.97
Method
deterministic
MBR-000680CLM-422524
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003742
Orphan claim re-pointed
Claims processor
CLM-404734 → UHC-45165-10 (Anna Mason)
Member id
UHC-45165-10
Confidence
1
Method
probabilistic
MBR-006750CLM-404734
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003743
Orphan claim re-pointed
Claims processor
CLM-403465 → UHC-72887-01 (Ethan Arnold)
Member id
UHC-72887-01
Confidence
1
Method
probabilistic
MBR-024986CLM-403465
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003744
Orphan claim re-pointed
Claims processor
CLM-409986 → UHC-32516-68 (Nicole Hayes)
Member id
UHC-32516-68
Confidence
1
Method
probabilistic
MBR-038832CLM-409986
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003745
Orphan claim re-pointed
Claims processor
CLM-429546 → UHC-36389-70 (Jacob Coleman)
Member id
UHC-36389-70
Confidence
1
Method
probabilistic
MBR-007509CLM-429546
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003746
Orphan claim re-pointed
Claims processor
CLM-426920 → UHC-33271-88 (Omar Li)
Member id
UHC-33271-88
Confidence
1
Method
probabilistic
MBR-022335CLM-426920
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003747
Orphan claim re-pointed
Claims processor
CLM-417742 → UHC-87202-79 (Bryan Simmons)
Member id
UHC-87202-79
Confidence
1
Method
probabilistic
MBR-024248CLM-417742
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003748
Orphan claim re-pointed
Claims processor
CLM-401016 → UHC-41992-20 (Janet Gibson)
Member id
UHC-41992-20
Confidence
1
Method
probabilistic
MBR-042183CLM-401016
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003749
Orphan claim re-pointed
Claims processor
CLM-412450 → UHC-47662-48 (Kevin Lewis)
Member id
UHC-47662-48
Confidence
1
Method
probabilistic
MBR-024802CLM-412450
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003750
Orphan claim re-pointed
Claims processor
CLM-400516 → UHC-36510-42 (Laura Evasn)
Member id
UHC-36510-42
Confidence
0.96
Method
probabilistic
MBR-034870CLM-400516
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003751
Orphan claim re-pointed
Claims processor
CLM-415657 → UHC-07484-53 (Jack Garza)
Member id
UHC-07484-53
Confidence
1
Method
probabilistic
MBR-021847CLM-415657
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003752
Orphan claim re-pointed
Claims processor
CLM-423063 → UHC-20571-96 (Beverly Valdez)
Member id
UHC-20571-96
Confidence
0.97
Method
deterministic
MBR-028724CLM-423063
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003753
Orphan claim re-pointed
Claims processor
CLM-409025 → UHC-17641-98 (Laura Gmez)
Member id
UHC-17641-98
Confidence
0.97
Method
deterministic
MBR-033034CLM-409025
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003754
Orphan claim re-pointed
Claims processor
CLM-420200 → UHC-20155-43 (Mateo Alvarez)
Member id
UHC-20155-43
Confidence
1
Method
probabilistic
MBR-027959CLM-420200
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003755
Orphan claim re-pointed
Claims processor
CLM-421302 → UHC-90488-46 (Amy Hamilton)
Member id
UHC-90488-46
Confidence
1
Method
probabilistic
MBR-011159CLM-421302
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003756
Orphan claim re-pointed
Claims processor
CLM-412545 → UHC-99536-64 (Shirley Ryan)
Member id
UHC-99536-64
Confidence
1
Method
probabilistic
MBR-006171CLM-412545
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003757
Orphan claim re-pointed
Claims processor
CLM-415257 → UHC-15656-39 (Janet Reynolds)
Member id
UHC-15656-39
Confidence
1
Method
probabilistic
MBR-024378CLM-415257
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003758
Orphan claim re-pointed
Claims processor
CLM-422687 → UHC-56657-20 (Heather Cook)
Member id
UHC-56657-20
Confidence
1
Method
probabilistic
MBR-006659CLM-422687
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003759
Orphan claim re-pointed
Claims processor
CLM-401017 → UHC-88238-52 (Melissa Moreno)
Member id
UHC-88238-52
Confidence
1
Method
probabilistic
MBR-034402CLM-401017
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003760
Orphan claim re-pointed
Claims processor
CLM-403015 → UHC-35766-20 (Lauren Alexander)
Member id
UHC-35766-20
Confidence
0.90
Method
probabilistic
MBR-039333CLM-403015
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003761
Orphan claim re-pointed
Claims processor
CLM-414754 → UHC-58349-43 (Andrea Davis)
Member id
UHC-58349-43
Confidence
0.98
Method
probabilistic
MBR-024226CLM-414754
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003762
Orphan claim re-pointed
Claims processor
CLM-411311 → UHC-81368-61 (Alexander Reynolds)
Member id
UHC-81368-61
Confidence
1
Method
probabilistic
MBR-002525CLM-411311
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003763
Orphan claim re-pointed
Claims processor
CLM-411671 → UHC-67995-44 (Donna Stephens)
Member id
UHC-67995-44
Confidence
1
Method
probabilistic
MBR-007193CLM-411671
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003764
Orphan claim re-pointed
Claims processor
CLM-414199 → UHC-77438-22 (Mari Larson)
Member id
UHC-77438-22
Confidence
0.97
Method
deterministic
MBR-012173CLM-414199
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003765
Orphan claim re-pointed
Claims processor
CLM-430341 → UHC-58887-83 (Raymond Carlson)
Member id
UHC-58887-83
Confidence
1
Method
probabilistic
MBR-016518CLM-430341
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003766
Orphan claim re-pointed
Claims processor
CLM-405344 → UHC-08356-33 (Mateo Armstrong)
Member id
UHC-08356-33
Confidence
1
Method
probabilistic
MBR-034429CLM-405344
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003767
Orphan claim re-pointed
Claims processor
CLM-427433 → UHC-87575-98 (Maria Munoz)
Member id
UHC-87575-98
Confidence
0.99
Method
probabilistic
MBR-026177CLM-427433
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003768
Orphan claim re-pointed
Claims processor
CLM-432381 → UHC-75420-71 (Debra Stevens)
Member id
UHC-75420-71
Confidence
1
Method
probabilistic
MBR-006429CLM-432381
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003769
Orphan claim re-pointed
Claims processor
CLM-402239 → UHC-06321-35 (Marilyn Rojas)
Member id
UHC-06321-35
Confidence
1
Method
probabilistic
MBR-000027CLM-402239
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003770
Orphan claim re-pointed
Claims processor
CLM-428071 → UHC-98453-76 (Janice Hamilton)
Member id
UHC-98453-76
Confidence
1
Method
probabilistic
MBR-033953CLM-428071
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003771
Orphan claim re-pointed
Claims processor
CLM-424188 → UHC-25170-71 (Janice Schultz)
Member id
UHC-25170-71
Confidence
1
Method
probabilistic
MBR-038172CLM-424188
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003772
Orphan claim re-pointed
Claims processor
CLM-422143 → UHC-88614-34 (Joan Edwards)
Member id
UHC-88614-34
Confidence
1
Method
probabilistic
MBR-008807CLM-422143
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003773
Orphan claim re-pointed
Claims processor
CLM-410534 → UHC-25382-23 (Gary Simpson)
Member id
UHC-25382-23
Confidence
0.97
Method
deterministic
MBR-031876CLM-410534
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003774
Orphan claim re-pointed
Claims processor
CLM-401539 → UHC-06689-67 (Jeffrey Silva)
Member id
UHC-06689-67
Confidence
1
Method
probabilistic
MBR-043292CLM-401539
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003775
Orphan claim re-pointed
Claims processor
CLM-420264 → UHC-69476-29 (Christopher Rios)
Member id
UHC-69476-29
Confidence
0.97
Method
deterministic
MBR-021520CLM-420264
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003776
Orphan claim re-pointed
Claims processor
CLM-410332 → UHC-83733-33 (Ryan Howard)
Member id
UHC-83733-33
Confidence
1
Method
probabilistic
MBR-015916CLM-410332
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003777
Orphan claim re-pointed
Claims processor
CLM-425121 → UHC-08596-95 (Kaen Oliver)
Member id
UHC-08596-95
Confidence
0.99
Method
probabilistic
MBR-012551CLM-425121
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003778
Orphan claim re-pointed
Claims processor
CLM-411847 → UHC-57625-59 (Beverly Sanchez)
Member id
UHC-57625-59
Confidence
1.00
Method
probabilistic
MBR-012914CLM-411847
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003779
Orphan claim re-pointed
Claims processor
CLM-404537 → UHC-88580-44 (Lisa Silva)
Member id
UHC-88580-44
Confidence
1
Method
probabilistic
MBR-012074CLM-404537
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003780
Orphan claim re-pointed
Claims processor
CLM-428369 → UHC-50527-90 (Scott Kelley)
Member id
UHC-50527-90
Confidence
1
Method
probabilistic
MBR-001858CLM-428369
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003781
Orphan claim re-pointed
Claims processor
CLM-426172 → UHC-71488-13 (Carl Sims)
Member id
UHC-71488-13
Confidence
0.98
Method
probabilistic
MBR-032145CLM-426172
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003782
Orphan claim re-pointed
Claims processor
CLM-423562 → UHC-16696-69 (Hannah Brooks)
Member id
UHC-16696-69
Confidence
1
Method
probabilistic
MBR-005567CLM-423562
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003783
Orphan claim re-pointed
Claims processor
CLM-424056 → UHC-25577-22 (Carl Bennett)
Member id
UHC-25577-22
Confidence
1
Method
probabilistic
MBR-002584CLM-424056
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003784
Orphan claim re-pointed
Claims processor
CLM-426443 → UHC-42495-13 (Doris Rivera)
Member id
UHC-42495-13
Confidence
0.99
Method
probabilistic
MBR-033540CLM-426443
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003785
Orphan claim re-pointed
Claims processor
CLM-414859 → UHC-90304-33 (Nancy Rojas)
Member id
UHC-90304-33
Confidence
1
Method
probabilistic
MBR-011210CLM-414859
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003786
Orphan claim re-pointed
Claims processor
CLM-405942 → UHC-52481-89 (Douglas Walker)
Member id
UHC-52481-89
Confidence
1
Method
probabilistic
MBR-030623CLM-405942
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003787
Orphan claim re-pointed
Claims processor
CLM-415072 → UHC-49232-31 (Karen Roberts)
Member id
UHC-49232-31
Confidence
0.97
Method
deterministic
MBR-024032CLM-415072
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003788
Orphan claim re-pointed
Claims processor
CLM-431093 → UHC-97823-17 (Beverly Brown)
Member id
UHC-97823-17
Confidence
1
Method
probabilistic
MBR-030738CLM-431093
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003789
Orphan claim re-pointed
Claims processor
CLM-430738 → UHC-47531-25 (Roy Daniels)
Member id
UHC-47531-25
Confidence
1
Method
probabilistic
MBR-027371CLM-430738
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 49 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.