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-001540
Orphan claim re-pointed
Claims processor
CLM-403638 → UHC-81471-19 (Nicole Wood)
Member id
UHC-81471-19
Confidence
1
Method
probabilistic
MBR-002023CLM-403638
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001541
Orphan claim re-pointed
Claims processor
CLM-400900 → UHC-70464-74 (Gary Valdez)
Member id
UHC-70464-74
Confidence
0.97
Method
deterministic
MBR-028237CLM-400900
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001542
Orphan claim re-pointed
Claims processor
CLM-407428 → UHC-30601-68 (Kenneth Chavez)
Member id
UHC-30601-68
Confidence
0.97
Method
deterministic
MBR-027230CLM-407428
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001543
Orphan claim re-pointed
Claims processor
CLM-420564 → UHC-97571-27 (Vincent Gutierrez)
Member id
UHC-97571-27
Confidence
0.97
Method
deterministic
MBR-042736CLM-420564
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001544
Orphan claim re-pointed
Claims processor
CLM-401879 → UHC-51254-08 (Patricia Wood)
Member id
UHC-51254-08
Confidence
1
Method
probabilistic
MBR-027385CLM-401879
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001545
Orphan claim re-pointed
Claims processor
CLM-415177 → UHC-59069-95 (Peter Alexander)
Member id
UHC-59069-95
Confidence
0.97
Method
deterministic
MBR-003936CLM-415177
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001546
Orphan claim re-pointed
Claims processor
CLM-426668 → UHC-71604-82 (Ana Lee)
Member id
UHC-71604-82
Confidence
1
Method
probabilistic
MBR-031901CLM-426668
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001547
Orphan claim re-pointed
Claims processor
CLM-419683 → UHC-04711-59 (Dorothy Lawrence)
Member id
UHC-04711-59
Confidence
1
Method
probabilistic
MBR-015146CLM-419683
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001548
Orphan claim re-pointed
Claims processor
CLM-428229 → UHC-42145-76 (Bryan Foster)
Member id
UHC-42145-76
Confidence
1
Method
probabilistic
MBR-003172CLM-428229
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001549
Orphan claim re-pointed
Claims processor
CLM-413005 → UHC-73108-23 (Lauren Valdez)
Member id
UHC-73108-23
Confidence
0.97
Method
deterministic
MBR-040989CLM-413005
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001550
Orphan claim re-pointed
Claims processor
CLM-400811 → UHC-21934-36 (Brandon Russell)
Member id
UHC-21934-36
Confidence
0.97
Method
deterministic
MBR-019074CLM-400811
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001551
Orphan claim re-pointed
Claims processor
CLM-423257 → UHC-59331-75 (Mark Howell)
Member id
UHC-59331-75
Confidence
0.97
Method
deterministic
MBR-005541CLM-423257
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001552
Orphan claim re-pointed
Claims processor
CLM-429918 → UHC-95888-71 (Ana McCoy)
Member id
UHC-95888-71
Confidence
0.97
Method
deterministic
MBR-039127CLM-429918
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001553
Orphan claim re-pointed
Claims processor
CLM-401105 → UHC-16502-55 (Sara James)
Member id
UHC-16502-55
Confidence
0.98
Method
probabilistic
MBR-013161CLM-401105
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001554
Orphan claim re-pointed
Claims processor
CLM-422049 → UHC-73484-68 (Eric Hall)
Member id
UHC-73484-68
Confidence
0.98
Method
probabilistic
MBR-022895CLM-422049
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001555
Orphan claim re-pointed
Claims processor
CLM-416581 → UHC-04462-47 (Mason Ramirez)
Member id
UHC-04462-47
Confidence
0.99
Method
probabilistic
MBR-001938CLM-416581
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001556
Orphan claim re-pointed
Claims processor
CLM-407577 → UHC-14958-17 (Mateo Salazar)
Member id
UHC-14958-17
Confidence
1
Method
probabilistic
MBR-029474CLM-407577
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001557
Orphan claim re-pointed
Claims processor
CLM-415988 → UHC-34995-40 (Teresa Reyes)
Member id
UHC-34995-40
Confidence
1
Method
probabilistic
MBR-040347CLM-415988
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001558
Orphan claim re-pointed
Claims processor
CLM-420748 → UHC-05632-94 (Walter Hernandez)
Member id
UHC-05632-94
Confidence
0.97
Method
deterministic
MBR-007723CLM-420748
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001559
Orphan claim re-pointed
Claims processor
CLM-408990 → UHC-64589-54 (Ashley Hansen)
Member id
UHC-64589-54
Confidence
1
Method
probabilistic
MBR-000594CLM-408990
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001560
Orphan claim re-pointed
Claims processor
CLM-416312 → UHC-78882-41 (Kathleen Johnston)
Member id
UHC-78882-41
Confidence
0.97
Method
deterministic
MBR-009752CLM-416312
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001561
Orphan claim re-pointed
Claims processor
CLM-405233 → UHC-52836-55 (Victoria Hawkins)
Member id
UHC-52836-55
Confidence
0.97
Method
deterministic
MBR-018388CLM-405233
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001562
Orphan claim re-pointed
Claims processor
CLM-412316 → UHC-80658-32 (John Burke)
Member id
UHC-80658-32
Confidence
0.97
Method
deterministic
MBR-019321CLM-412316
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001563
Orphan claim re-pointed
Claims processor
CLM-427026 → UHC-51192-01 (Megan Grant)
Member id
UHC-51192-01
Confidence
1
Method
probabilistic
MBR-012447CLM-427026
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001564
Orphan claim re-pointed
Claims processor
CLM-425745 → UHC-11038-16 (Li Li)
Member id
UHC-11038-16
Confidence
0.99
Method
probabilistic
MBR-023628CLM-425745
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001565
Orphan claim re-pointed
Claims processor
CLM-401137 → UHC-27759-35 (Natalie Williams)
Member id
UHC-27759-35
Confidence
1
Method
probabilistic
MBR-002986CLM-401137
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001566
Orphan claim re-pointed
Claims processor
CLM-417430 → UHC-97871-08 (Maria Jenkins)
Member id
UHC-97871-08
Confidence
0.94
Method
probabilistic
MBR-022457CLM-417430
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001567
Orphan claim re-pointed
Claims processor
CLM-421779 → UHC-68512-24 (Rachel Anderson)
Member id
UHC-68512-24
Confidence
0.97
Method
deterministic
MBR-016180CLM-421779
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001568
Orphan claim re-pointed
Claims processor
CLM-403482 → UHC-38295-18 (Nicole Lucas)
Member id
UHC-38295-18
Confidence
1
Method
probabilistic
MBR-035714CLM-403482
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001569
Orphan claim re-pointed
Claims processor
CLM-418200 → UHC-57655-78 (Laura Guzman)
Member id
UHC-57655-78
Confidence
1
Method
probabilistic
MBR-022803CLM-418200
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001570
Orphan claim re-pointed
Claims processor
CLM-419890 → UHC-50533-10 (Elijah Adams)
Member id
UHC-50533-10
Confidence
1
Method
probabilistic
MBR-004023CLM-419890
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001571
Orphan claim re-pointed
Claims processor
CLM-409058 → UHC-66414-72 (Aisha Long)
Member id
UHC-66414-72
Confidence
1
Method
probabilistic
MBR-026565CLM-409058
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001572
Orphan claim re-pointed
Claims processor
CLM-421412 → UHC-39923-61 (Stephen Jimenez)
Member id
UHC-39923-61
Confidence
1
Method
probabilistic
MBR-010035CLM-421412
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001573
Orphan claim re-pointed
Claims processor
CLM-427736 → UHC-07805-06 (Lucia Hughes)
Member id
UHC-07805-06
Confidence
0.97
Method
deterministic
MBR-028977CLM-427736
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001574
Orphan claim re-pointed
Claims processor
CLM-403309 → UHC-36773-55 (Judy Harvey)
Member id
UHC-36773-55
Confidence
1
Method
probabilistic
MBR-030348CLM-403309
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001575
Orphan claim re-pointed
Claims processor
CLM-410828 → UHC-08400-52 (Justin Estrada)
Member id
UHC-08400-52
Confidence
0.97
Method
deterministic
MBR-000054CLM-410828
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001576
Orphan claim re-pointed
Claims processor
CLM-400234 → UHC-96990-15 (Angela Espinoza)
Member id
UHC-96990-15
Confidence
0.99
Method
probabilistic
MBR-017663CLM-400234
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001577
Orphan claim re-pointed
Claims processor
CLM-418722 → UHC-11833-22 (Ralph Bell)
Member id
UHC-11833-22
Confidence
0.99
Method
probabilistic
MBR-034841CLM-418722
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001578
Orphan claim re-pointed
Claims processor
CLM-411576 → UHC-66914-34 (Kyle Ortega)
Member id
UHC-66914-34
Confidence
1
Method
probabilistic
MBR-021980CLM-411576
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001579
Orphan claim re-pointed
Claims processor
CLM-431535 → UHC-98440-07 (Amanda Li)
Member id
UHC-98440-07
Confidence
1
Method
probabilistic
MBR-033044CLM-431535
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001580
Orphan claim re-pointed
Claims processor
CLM-400835 → UHC-82880-52 (Julie Webb)
Member id
UHC-82880-52
Confidence
0.97
Method
deterministic
MBR-012565CLM-400835
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001581
Orphan claim re-pointed
Claims processor
CLM-402587 → UHC-34799-44 (Jennifer Oliver)
Member id
UHC-34799-44
Confidence
1
Method
probabilistic
MBR-017493CLM-402587
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001582
Orphan claim re-pointed
Claims processor
CLM-414941 → UHC-74433-78 (Benjamin Contreras)
Member id
UHC-74433-78
Confidence
1
Method
probabilistic
MBR-013639CLM-414941
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001583
Orphan claim re-pointed
Claims processor
CLM-412479 → UHC-55006-25 (Samuel Kelley)
Member id
UHC-55006-25
Confidence
0.97
Method
deterministic
MBR-011228CLM-412479
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001584
Orphan claim re-pointed
Claims processor
CLM-411960 → UHC-81594-20 (Pamela Ortega)
Member id
UHC-81594-20
Confidence
1
Method
probabilistic
MBR-027731CLM-411960
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001585
Orphan claim re-pointed
Claims processor
CLM-405970 → UHC-91270-07 (Larry Bowman)
Member id
UHC-91270-07
Confidence
0.97
Method
deterministic
MBR-019835CLM-405970
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001586
Orphan claim re-pointed
Claims processor
CLM-431778 → UHC-23575-96 (Ashley Carter)
Member id
UHC-23575-96
Confidence
0.97
Method
deterministic
MBR-028591CLM-431778
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001587
Orphan claim re-pointed
Claims processor
CLM-430226 → UHC-66078-28 (Aisha Gray)
Member id
UHC-66078-28
Confidence
1
Method
probabilistic
MBR-022080CLM-430226
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001588
Orphan claim re-pointed
Claims processor
CLM-409995 → UHC-15361-56 (Jean Williamson)
Member id
UHC-15361-56
Confidence
1
Method
probabilistic
MBR-003613CLM-409995
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001589
Orphan claim re-pointed
Claims processor
CLM-429356 → UHC-30144-81 (Janet Weaver)
Member id
UHC-30144-81
Confidence
1
Method
probabilistic
MBR-009403CLM-429356
Executed
resolution_agent
2026-10-19 19:54:39
9,112 rows, page 5 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.