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-003890
Orphan claim re-pointed
Claims processor
CLM-406623 → UHC-53630-10 (Kathleen Graham)
Member id
UHC-53630-10
Confidence
1
Method
probabilistic
MBR-026388CLM-406623
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003891
Orphan claim re-pointed
Claims processor
CLM-419710 → UHC-99410-20 (Abby Arnold)
Member id
UHC-99410-20
Confidence
0.97
Method
deterministic
MBR-043766CLM-419710
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003892
Orphan claim re-pointed
Claims processor
CLM-403941 → UHC-72695-92 (Elijah Pena)
Member id
UHC-72695-92
Confidence
1
Method
probabilistic
MBR-031145CLM-403941
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003893
Orphan claim re-pointed
Claims processor
CLM-412579 → UHC-11667-88 (Shirley Sanchez)
Member id
UHC-11667-88
Confidence
0.97
Method
deterministic
MBR-012117CLM-412579
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003894
Orphan claim re-pointed
Claims processor
CLM-410096 → UHC-65603-12 (Gary Rodriguez)
Member id
UHC-65603-12
Confidence
1
Method
probabilistic
MBR-022270CLM-410096
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003895
Orphan claim re-pointed
Claims processor
CLM-405380 → UHC-83550-98 (Anthony Banks)
Member id
UHC-83550-98
Confidence
1
Method
probabilistic
MBR-028943CLM-405380
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003896
Orphan claim re-pointed
Claims processor
CLM-412227 → UHC-54651-03 (Megan Rios)
Member id
UHC-54651-03
Confidence
0.97
Method
deterministic
MBR-024914CLM-412227
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003897
Orphan claim re-pointed
Claims processor
CLM-408061 → UHC-99058-30 (Bruce Ward)
Member id
UHC-99058-30
Confidence
0.98
Method
probabilistic
MBR-007853CLM-408061
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003898
Orphan claim re-pointed
Claims processor
CLM-408258 → UHC-22039-25 (Walter Weber)
Member id
UHC-22039-25
Confidence
0.93
Method
probabilistic
MBR-039445CLM-408258
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003899
Orphan claim re-pointed
Claims processor
CLM-412765 → UHC-87809-79 (Steven Cook)
Member id
UHC-87809-79
Confidence
0.93
Method
probabilistic
MBR-026335CLM-412765
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003900
Orphan claim re-pointed
Claims processor
CLM-405128 → UHC-49921-75 (Denise Scott)
Member id
UHC-49921-75
Confidence
0.97
Method
deterministic
MBR-012017CLM-405128
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003901
Orphan claim re-pointed
Claims processor
CLM-417329 → UHC-18243-61 (Michael Flores)
Member id
UHC-18243-61
Confidence
1
Method
probabilistic
MBR-004183CLM-417329
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003902
Orphan claim re-pointed
Claims processor
CLM-413980 → UHC-58277-73 (Samuel Padilla)
Member id
UHC-58277-73
Confidence
0.97
Method
probabilistic
MBR-015925CLM-413980
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003903
Orphan claim re-pointed
Claims processor
CLM-424077 → UHC-63640-79 (Priya Ortiz)
Member id
UHC-63640-79
Confidence
1
Method
probabilistic
MBR-032320CLM-424077
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003904
Orphan claim re-pointed
Claims processor
CLM-409605 → UHC-12032-61 (Catherine Mendez)
Member id
UHC-12032-61
Confidence
0.93
Method
probabilistic
MBR-006988CLM-409605
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003905
Orphan claim re-pointed
Claims processor
CLM-428773 → UHC-33961-52 (Aaron Rojas)
Member id
UHC-33961-52
Confidence
1
Method
probabilistic
MBR-022552CLM-428773
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003906
Orphan claim re-pointed
Claims processor
CLM-417140 → UHC-77504-30 (Valentina Wood)
Member id
UHC-77504-30
Confidence
1
Method
probabilistic
MBR-011874CLM-417140
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003907
Orphan claim re-pointed
Claims processor
CLM-406622 → UHC-53630-10 (Kathleen Graham)
Member id
UHC-53630-10
Confidence
1
Method
probabilistic
MBR-026388CLM-406622
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003908
Orphan claim re-pointed
Claims processor
CLM-432817 → UHC-87647-23 (Brittany Reyes)
Member id
UHC-87647-23
Confidence
1
Method
probabilistic
MBR-010562CLM-432817
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003909
Orphan claim re-pointed
Claims processor
CLM-403624 → UHC-49193-58 (Jack Knight)
Member id
UHC-49193-58
Confidence
1
Method
probabilistic
MBR-030430CLM-403624
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003910
Orphan claim re-pointed
Claims processor
CLM-406128 → UHC-68864-27 (Michelle Nelson)
Member id
UHC-68864-27
Confidence
1
Method
probabilistic
MBR-027654CLM-406128
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003911
Orphan claim re-pointed
Claims processor
CLM-424707 → UHC-79738-91 (Nathan Yang)
Member id
UHC-79738-91
Confidence
1
Method
probabilistic
MBR-005531CLM-424707
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003912
Orphan claim re-pointed
Claims processor
CLM-400057 → UHC-53829-66 (Laura Hamilton)
Member id
UHC-53829-66
Confidence
0.99
Method
probabilistic
MBR-000365CLM-400057
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003913
Orphan claim re-pointed
Claims processor
CLM-404412 → UHC-70105-62 (Jeffrey Jordan)
Member id
UHC-70105-62
Confidence
1
Method
probabilistic
MBR-002603CLM-404412
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003914
Orphan claim re-pointed
Claims processor
CLM-402729 → UHC-92968-09 (Ana Coleman)
Member id
UHC-92968-09
Confidence
1
Method
probabilistic
MBR-004518CLM-402729
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003915
Orphan claim re-pointed
Claims processor
CLM-405474 → UHC-39661-50 (Albert Olson)
Member id
UHC-39661-50
Confidence
0.97
Method
deterministic
MBR-022569CLM-405474
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003916
Orphan claim re-pointed
Claims processor
CLM-407390 → UHC-52903-44 (Philip Dean)
Member id
UHC-52903-44
Confidence
0.99
Method
probabilistic
MBR-026107CLM-407390
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003917
Orphan claim re-pointed
Claims processor
CLM-402043 → UHC-47109-16 (Scott Shaw)
Member id
UHC-47109-16
Confidence
0.99
Method
probabilistic
MBR-003939CLM-402043
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003918
Orphan claim re-pointed
Claims processor
CLM-425071 → UHC-85183-78 (Joan Fowler)
Member id
UHC-85183-78
Confidence
0.98
Method
probabilistic
MBR-003885CLM-425071
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003919
Orphan claim re-pointed
Claims processor
CLM-413068 → UHC-57923-64 (Stephen Montgomery)
Member id
UHC-57923-64
Confidence
1
Method
probabilistic
MBR-011326CLM-413068
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003920
Orphan claim re-pointed
Claims processor
CLM-403995 → UHC-55267-90 (Virginia Cook)
Member id
UHC-55267-90
Confidence
1
Method
probabilistic
MBR-000603CLM-403995
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003921
Orphan claim re-pointed
Claims processor
CLM-418035 → UHC-77509-21 (William Williams)
Member id
UHC-77509-21
Confidence
1
Method
probabilistic
MBR-012226CLM-418035
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003922
Orphan claim re-pointed
Claims processor
CLM-427170 → UHC-11439-98 (Bryan Black)
Member id
UHC-11439-98
Confidence
1
Method
probabilistic
MBR-003456CLM-427170
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003923
Orphan claim re-pointed
Claims processor
CLM-405615 → UHC-02617-99 (Amber Garza)
Member id
UHC-02617-99
Confidence
1
Method
probabilistic
MBR-025105CLM-405615
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003924
Orphan claim re-pointed
Claims processor
CLM-407696 → UHC-94741-69 (Robert Weber)
Member id
UHC-94741-69
Confidence
1
Method
probabilistic
MBR-003015CLM-407696
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003925
Orphan claim re-pointed
Claims processor
CLM-419832 → UHC-52792-25 (Daniel Elliott)
Member id
UHC-52792-25
Confidence
1
Method
probabilistic
MBR-013941CLM-419832
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003926
Orphan claim re-pointed
Claims processor
CLM-407162 → UHC-30657-74 (Ryan Duncan)
Member id
UHC-30657-74
Confidence
1
Method
probabilistic
MBR-001461CLM-407162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003927
Orphan claim re-pointed
Claims processor
CLM-421455 → UHC-93320-87 (Bruce Jensen)
Member id
UHC-93320-87
Confidence
1
Method
probabilistic
MBR-014734CLM-421455
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003928
Orphan claim re-pointed
Claims processor
CLM-418817 → UHC-15997-66 (Henry Jordan)
Member id
UHC-15997-66
Confidence
1
Method
probabilistic
MBR-009883CLM-418817
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003929
Orphan claim re-pointed
Claims processor
CLM-430868 → UHC-22981-87 (Dennis Brown)
Member id
UHC-22981-87
Confidence
1
Method
probabilistic
MBR-016906CLM-430868
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003930
Orphan claim re-pointed
Claims processor
CLM-420752 → UHC-54629-26 (Mariana Arnold)
Member id
UHC-54629-26
Confidence
1
Method
probabilistic
MBR-015247CLM-420752
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003931
Orphan claim re-pointed
Claims processor
CLM-431204 → UHC-59050-84 (Bradley Jones)
Member id
UHC-59050-84
Confidence
1
Method
probabilistic
MBR-015973CLM-431204
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003932
Orphan claim re-pointed
Claims processor
CLM-423663 → UHC-34876-67 (Eugene Franklin)
Member id
UHC-34876-67
Confidence
1
Method
probabilistic
MBR-001018CLM-423663
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003933
Orphan claim re-pointed
Claims processor
CLM-411251 → UHC-98163-77 (Heather Webb)
Member id
UHC-98163-77
Confidence
1
Method
probabilistic
MBR-010511CLM-411251
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003934
Orphan claim re-pointed
Claims processor
CLM-411626 → UHC-14707-79 (Santiago Henry)
Member id
UHC-14707-79
Confidence
1
Method
probabilistic
MBR-017957CLM-411626
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003935
Orphan claim re-pointed
Claims processor
CLM-403696 → UHC-19046-98 (Christina Burke)
Member id
UHC-19046-98
Confidence
0.93
Method
probabilistic
MBR-042746CLM-403696
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003936
Orphan claim re-pointed
Claims processor
CLM-420518 → UHC-74228-68 (Abbby Wong)
Member id
UHC-74228-68
Confidence
0.93
Method
probabilistic
MBR-041276CLM-420518
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003937
Orphan claim re-pointed
Claims processor
CLM-429774 → UHC-49905-75 (Kathryn Wallace)
Member id
UHC-49905-75
Confidence
0.97
Method
deterministic
MBR-029216CLM-429774
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003938
Orphan claim re-pointed
Claims processor
CLM-402648 → UHC-17562-29 (George Brown)
Member id
UHC-17562-29
Confidence
1
Method
probabilistic
MBR-017757CLM-402648
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003939
Orphan claim re-pointed
Claims processor
CLM-428938 → UHC-10473-09 (Victoria Nunez)
Member id
UHC-10473-09
Confidence
1
Method
probabilistic
MBR-002654CLM-428938
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 52 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.