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-003840
Orphan claim re-pointed
Claims processor
CLM-420039 → UHC-96523-84 (Kayla Cole)
Member id
UHC-96523-84
Confidence
1
Method
probabilistic
MBR-013700CLM-420039
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003841
Orphan claim re-pointed
Claims processor
CLM-414874 → UHC-06004-43 (Wei Romero)
Member id
UHC-06004-43
Confidence
1
Method
probabilistic
MBR-021169CLM-414874
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003842
Orphan claim re-pointed
Claims processor
CLM-424488 → UHC-59681-63 (Douglas Stephens)
Member id
UHC-59681-63
Confidence
1
Method
probabilistic
MBR-006488CLM-424488
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003843
Orphan claim re-pointed
Claims processor
CLM-426078 → UHC-23575-28 (Lauren Peters)
Member id
UHC-23575-28
Confidence
1
Method
probabilistic
MBR-009118CLM-426078
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003844
Orphan claim re-pointed
Claims processor
CLM-404108 → UHC-34223-83 (Carol Stevens)
Member id
UHC-34223-83
Confidence
0.98
Method
probabilistic
MBR-025490CLM-404108
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003845
Orphan claim re-pointed
Claims processor
CLM-426461 → UHC-23862-12 (Heather Long)
Member id
UHC-23862-12
Confidence
1.00
Method
probabilistic
MBR-009822CLM-426461
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003846
Orphan claim re-pointed
Claims processor
CLM-419795 → UHC-32104-52 (Patricia Fox)
Member id
UHC-32104-52
Confidence
0.97
Method
deterministic
MBR-025384CLM-419795
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003847
Orphan claim re-pointed
Claims processor
CLM-401521 → UHC-93729-34 (Gloria Perry)
Member id
UHC-93729-34
Confidence
0.99
Method
probabilistic
MBR-014602CLM-401521
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003848
Orphan claim re-pointed
Claims processor
CLM-403087 → UHC-95054-93 (Valentina Banks)
Member id
UHC-95054-93
Confidence
1
Method
probabilistic
MBR-005548CLM-403087
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003849
Orphan claim re-pointed
Claims processor
CLM-405085 → UHC-84948-25 (Judith Lopez)
Member id
UHC-84948-25
Confidence
1
Method
probabilistic
MBR-003221CLM-405085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003850
Orphan claim re-pointed
Claims processor
CLM-407300 → UHC-08247-33 (Rachel Crawford)
Member id
UHC-08247-33
Confidence
1
Method
probabilistic
MBR-013249CLM-407300
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003851
Orphan claim re-pointed
Claims processor
CLM-414193 → UHC-19695-21 (Henry Holmes)
Member id
UHC-19695-21
Confidence
1
Method
probabilistic
MBR-039441CLM-414193
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003852
Orphan claim re-pointed
Claims processor
CLM-403983 → UHC-17641-18 (Sandra Price)
Member id
UHC-17641-18
Confidence
1
Method
probabilistic
MBR-001514CLM-403983
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003853
Orphan claim re-pointed
Claims processor
CLM-410112 → UHC-15032-29 (Jose Watkins)
Member id
UHC-15032-29
Confidence
1
Method
probabilistic
MBR-015663CLM-410112
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003854
Orphan claim re-pointed
Claims processor
CLM-431045 → UHC-86497-82 (Christine Sullivan)
Member id
UHC-86497-82
Confidence
1
Method
probabilistic
MBR-014703CLM-431045
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003855
Orphan claim re-pointed
Claims processor
CLM-400430 → UHC-60033-71 (Bradley Carroll)
Member id
UHC-60033-71
Confidence
1
Method
probabilistic
MBR-016939CLM-400430
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003856
Orphan claim re-pointed
Claims processor
CLM-427644 → UHC-03883-52 (Luis Wang)
Member id
UHC-03883-52
Confidence
1
Method
probabilistic
MBR-019438CLM-427644
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003857
Orphan claim re-pointed
Claims processor
CLM-404842 → UHC-27496-70 (Yuki Nguyen)
Member id
UHC-27496-70
Confidence
1
Method
probabilistic
MBR-021547CLM-404842
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003858
Orphan claim re-pointed
Claims processor
CLM-410538 → UHC-61330-54 (Adam Bailey)
Member id
UHC-61330-54
Confidence
1
Method
probabilistic
MBR-008534CLM-410538
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003859
Orphan claim re-pointed
Claims processor
CLM-403857 → UHC-86487-52 (Mei Rogers)
Member id
UHC-86487-52
Confidence
0.93
Method
probabilistic
MBR-019218CLM-403857
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003860
Orphan claim re-pointed
Claims processor
CLM-401208 → UHC-00824-54 (Ana Knight)
Member id
UHC-00824-54
Confidence
0.99
Method
probabilistic
MBR-003187CLM-401208
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003861
Orphan claim re-pointed
Claims processor
CLM-428261 → UHC-39713-31 (Bryan Perry)
Member id
UHC-39713-31
Confidence
0.98
Method
probabilistic
MBR-016229CLM-428261
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003862
Orphan claim re-pointed
Claims processor
CLM-405588 → UHC-14844-78 (Omar Richardson)
Member id
UHC-14844-78
Confidence
0.99
Method
probabilistic
MBR-009660CLM-405588
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003863
Orphan claim re-pointed
Claims processor
CLM-418689 → UHC-19774-93 (Billy Anderson)
Member id
UHC-19774-93
Confidence
1
Method
probabilistic
MBR-010692CLM-418689
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003864
Orphan claim re-pointed
Claims processor
CLM-404558 → UHC-32163-09 (Beverly Nunez)
Member id
UHC-32163-09
Confidence
0.97
Method
deterministic
MBR-042675CLM-404558
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003865
Orphan claim re-pointed
Claims processor
CLM-420622 → UHC-84264-29 (Willie Yang)
Member id
UHC-84264-29
Confidence
1
Method
probabilistic
MBR-013723CLM-420622
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003866
Orphan claim re-pointed
Claims processor
CLM-431222 → UHC-81537-62 (Donna Morris)
Member id
UHC-81537-62
Confidence
1
Method
probabilistic
MBR-016107CLM-431222
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003867
Orphan claim re-pointed
Claims processor
CLM-408238 → UHC-94226-56 (Julia Estrada)
Member id
UHC-94226-56
Confidence
0.94
Method
probabilistic
MBR-010644CLM-408238
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003868
Orphan claim re-pointed
Claims processor
CLM-422919 → UHC-53530-87 (Alexis Parker)
Member id
UHC-53530-87
Confidence
1.00
Method
probabilistic
MBR-017429CLM-422919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003869
Orphan claim re-pointed
Claims processor
CLM-428608 → UHC-63078-75 (Madison Lawson)
Member id
UHC-63078-75
Confidence
1
Method
probabilistic
MBR-027050CLM-428608
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003870
Orphan claim re-pointed
Claims processor
CLM-402711 → UHC-98906-09 (Kayla Gardner)
Member id
UHC-98906-09
Confidence
1
Method
probabilistic
MBR-036775CLM-402711
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003871
Orphan claim re-pointed
Claims processor
CLM-414319 → UHC-19095-82 (Jlie Marshall)
Member id
UHC-19095-82
Confidence
0.99
Method
probabilistic
MBR-025438CLM-414319
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003872
Orphan claim re-pointed
Claims processor
CLM-414718 → UHC-58402-80 (Brandon Fernandez)
Member id
UHC-58402-80
Confidence
1
Method
probabilistic
MBR-000266CLM-414718
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003873
Orphan claim re-pointed
Claims processor
CLM-413041 → UHC-65942-65 (Jeremy Snyder)
Member id
UHC-65942-65
Confidence
1
Method
probabilistic
MBR-031800CLM-413041
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003874
Orphan claim re-pointed
Claims processor
CLM-420447 → UHC-93836-29 (Patrick Boyd)
Member id
UHC-93836-29
Confidence
0.93
Method
probabilistic
MBR-001790CLM-420447
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003875
Orphan claim re-pointed
Claims processor
CLM-403298 → UHC-95245-95 (Vincent Hanson)
Member id
UHC-95245-95
Confidence
1
Method
probabilistic
MBR-022550CLM-403298
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003876
Orphan claim re-pointed
Claims processor
CLM-418493 → UHC-44883-09 (Alexander Porter)
Member id
UHC-44883-09
Confidence
1
Method
probabilistic
MBR-010736CLM-418493
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003877
Orphan claim re-pointed
Claims processor
CLM-403852 → UHC-60731-35 (Larry Arnold)
Member id
UHC-60731-35
Confidence
1
Method
probabilistic
MBR-009807CLM-403852
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003878
Orphan claim re-pointed
Claims processor
CLM-410411 → UHC-67569-91 (Teresa Myers)
Member id
UHC-67569-91
Confidence
1
Method
probabilistic
MBR-015023CLM-410411
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003879
Orphan claim re-pointed
Claims processor
CLM-418848 → UHC-34859-38 (Jeremy Harvey)
Member id
UHC-34859-38
Confidence
1
Method
probabilistic
MBR-033031CLM-418848
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003880
Orphan claim re-pointed
Claims processor
CLM-422507 → UHC-07710-68 (Willie Hayes)
Member id
UHC-07710-68
Confidence
1
Method
probabilistic
MBR-022557CLM-422507
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003881
Orphan claim re-pointed
Claims processor
CLM-404707 → UHC-32418-96 (Yuki Espinoza)
Member id
UHC-32418-96
Confidence
1
Method
probabilistic
MBR-012164CLM-404707
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003882
Orphan claim re-pointed
Claims processor
CLM-409792 → UHC-60029-17 (Jacqueline Webb)
Member id
UHC-60029-17
Confidence
1
Method
probabilistic
MBR-016322CLM-409792
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003883
Orphan claim re-pointed
Claims processor
CLM-421833 → UHC-36825-92 (Larry Hanson)
Member id
UHC-36825-92
Confidence
1
Method
probabilistic
MBR-013985CLM-421833
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003884
Orphan claim re-pointed
Claims processor
CLM-426323 → UHC-99703-83 (Gloria Guzman)
Member id
UHC-99703-83
Confidence
1
Method
probabilistic
MBR-005756CLM-426323
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003885
Orphan claim re-pointed
Claims processor
CLM-424554 → UHC-35421-78 (Santiago Franklin)
Member id
UHC-35421-78
Confidence
0.97
Method
deterministic
MBR-002328CLM-424554
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003886
Orphan claim re-pointed
Claims processor
CLM-416973 → UHC-42690-59 (Jose Williamson)
Member id
UHC-42690-59
Confidence
1
Method
probabilistic
MBR-007273CLM-416973
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003887
Orphan claim re-pointed
Claims processor
CLM-409768 → UHC-58917-79 (Elijah Clark)
Member id
UHC-58917-79
Confidence
1
Method
probabilistic
MBR-015550CLM-409768
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003888
Orphan claim re-pointed
Claims processor
CLM-408053 → UHC-56097-83 (Thomas Kelly)
Member id
UHC-56097-83
Confidence
1
Method
probabilistic
MBR-027083CLM-408053
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003889
Orphan claim re-pointed
Claims processor
CLM-400408 → UHC-06862-81 (Aaron Harper)
Member id
UHC-06862-81
Confidence
1
Method
probabilistic
MBR-028504CLM-400408
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 51 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.