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-003940
Orphan claim re-pointed
Claims processor
CLM-408433 → UHC-85118-52 (Ryan Diaz)
Member id
UHC-85118-52
Confidence
1
Method
probabilistic
MBR-014971CLM-408433
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003941
Orphan claim re-pointed
Claims processor
CLM-427012 → UHC-97621-91 (Christian Clark)
Member id
UHC-97621-91
Confidence
1
Method
probabilistic
MBR-007525CLM-427012
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003942
Orphan claim re-pointed
Claims processor
CLM-413818 → UHC-52249-72 (Ann Salazar)
Member id
UHC-52249-72
Confidence
1
Method
probabilistic
MBR-032674CLM-413818
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003943
Orphan claim re-pointed
Claims processor
CLM-424829 → UHC-60006-41 (Jose Patterson)
Member id
UHC-60006-41
Confidence
1
Method
probabilistic
MBR-001492CLM-424829
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003944
Orphan claim re-pointed
Claims processor
CLM-410390 → UHC-16414-38 (Elijah Washington)
Member id
UHC-16414-38
Confidence
0.99
Method
probabilistic
MBR-038435CLM-410390
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003945
Orphan claim re-pointed
Claims processor
CLM-430445 → UHC-20978-25 (Bradley Padilla)
Member id
UHC-20978-25
Confidence
1
Method
probabilistic
MBR-004649CLM-430445
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003946
Orphan claim re-pointed
Claims processor
CLM-427052 → UHC-32542-57 (Bryan Castro)
Member id
UHC-32542-57
Confidence
0.97
Method
deterministic
MBR-014120CLM-427052
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003947
Orphan claim re-pointed
Claims processor
CLM-402880 → UHC-00431-81 (Diego Valdez)
Member id
UHC-00431-81
Confidence
1
Method
probabilistic
MBR-026803CLM-402880
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003948
Orphan claim re-pointed
Claims processor
CLM-408668 → UHC-47109-24 (Ruth Fisher)
Member id
UHC-47109-24
Confidence
1
Method
probabilistic
MBR-006286CLM-408668
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003949
Orphan claim re-pointed
Claims processor
CLM-429519 → UHC-80595-34 (Julia Luna)
Member id
UHC-80595-34
Confidence
1
Method
probabilistic
MBR-006921CLM-429519
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003950
Orphan claim re-pointed
Claims processor
CLM-401231 → UHC-31772-12 (Dennis Matthews)
Member id
UHC-31772-12
Confidence
1
Method
probabilistic
MBR-003525CLM-401231
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003951
Orphan claim re-pointed
Claims processor
CLM-432038 → UHC-60754-75 (Bobby Ortiz)
Member id
UHC-60754-75
Confidence
0.97
Method
deterministic
MBR-021519CLM-432038
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003952
Orphan claim re-pointed
Claims processor
CLM-416463 → UHC-05917-75 (Fatima Sanders)
Member id
UHC-05917-75
Confidence
1
Method
probabilistic
MBR-032665CLM-416463
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003953
Orphan claim re-pointed
Claims processor
CLM-401681 → UHC-35149-69 (Abigail Coleman)
Member id
UHC-35149-69
Confidence
1
Method
probabilistic
MBR-003873CLM-401681
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003954
Orphan claim re-pointed
Claims processor
CLM-414397 → UHC-35055-55 (Santiago Miller)
Member id
UHC-35055-55
Confidence
0.93
Method
probabilistic
MBR-008038CLM-414397
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003955
Orphan claim re-pointed
Claims processor
CLM-400399 → UHC-54640-63 (Shirley Watson)
Member id
UHC-54640-63
Confidence
1
Method
probabilistic
MBR-024323CLM-400399
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003956
Orphan claim re-pointed
Claims processor
CLM-405552 → UHC-62944-73 (Sara Carr)
Member id
UHC-62944-73
Confidence
1
Method
probabilistic
MBR-029652CLM-405552
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003957
Orphan claim re-pointed
Claims processor
CLM-418694 → UHC-08743-28 (Daniel Chavez)
Member id
UHC-08743-28
Confidence
0.99
Method
probabilistic
MBR-022391CLM-418694
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003958
Orphan claim re-pointed
Claims processor
CLM-430164 → UHC-29214-49 (Raymond Castillo)
Member id
UHC-29214-49
Confidence
1
Method
probabilistic
MBR-018223CLM-430164
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003959
Orphan claim re-pointed
Claims processor
CLM-420395 → UHC-34681-43 (Christian Simmonns)
Member id
UHC-34681-43
Confidence
0.93
Method
probabilistic
MBR-031724CLM-420395
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003960
Orphan claim re-pointed
Claims processor
CLM-408815 → UHC-84410-24 (Victoria Franklin)
Member id
UHC-84410-24
Confidence
1
Method
probabilistic
MBR-035547CLM-408815
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003961
Orphan claim re-pointed
Claims processor
CLM-406704 → UHC-66427-98 (Laura Murray)
Member id
UHC-66427-98
Confidence
1
Method
probabilistic
MBR-011613CLM-406704
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003962
Orphan claim re-pointed
Claims processor
CLM-407313 → UHC-00130-55 (Thomas Espinoza)
Member id
UHC-00130-55
Confidence
1
Method
probabilistic
MBR-025808CLM-407313
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003963
Orphan claim re-pointed
Claims processor
CLM-402541 → UHC-33344-70 (James Delgado)
Member id
UHC-33344-70
Confidence
1
Method
probabilistic
MBR-018511CLM-402541
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003964
Orphan claim re-pointed
Claims processor
CLM-408594 → UHC-19554-84 (Steven Holmes)
Member id
UHC-19554-84
Confidence
1
Method
probabilistic
MBR-003401CLM-408594
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003965
Orphan claim re-pointed
Claims processor
CLM-406442 → UHC-32131-64 (Priya Stone)
Member id
UHC-32131-64
Confidence
0.97
Method
deterministic
MBR-001405CLM-406442
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003966
Orphan claim re-pointed
Claims processor
CLM-431115 → UHC-09497-55 (Joe Vargas)
Member id
UHC-09497-55
Confidence
1
Method
probabilistic
MBR-004365CLM-431115
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003967
Orphan claim re-pointed
Claims processor
CLM-402570 → UHC-53180-13 (Andrew Cox)
Member id
UHC-53180-13
Confidence
1
Method
probabilistic
MBR-008357CLM-402570
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003968
Orphan claim re-pointed
Claims processor
CLM-404391 → UHC-45040-71 (Joe Flores)
Member id
UHC-45040-71
Confidence
0.99
Method
probabilistic
MBR-009435CLM-404391
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003969
Orphan claim re-pointed
Claims processor
CLM-414961 → UHC-56461-21 (Lucia Vega)
Member id
UHC-56461-21
Confidence
1
Method
probabilistic
MBR-011580CLM-414961
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003970
Orphan claim re-pointed
Claims processor
CLM-427186 → UHC-65862-40 (Ahmed Harrison)
Member id
UHC-65862-40
Confidence
1
Method
probabilistic
MBR-022151CLM-427186
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003971
Orphan claim re-pointed
Claims processor
CLM-411776 → UHC-64477-90 (Eric Elliott)
Member id
UHC-64477-90
Confidence
1
Method
probabilistic
MBR-004617CLM-411776
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003972
Orphan claim re-pointed
Claims processor
CLM-410372 → UHC-41438-71 (Ralph Jimenez)
Member id
UHC-41438-71
Confidence
0.93
Method
probabilistic
MBR-010395CLM-410372
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003973
Orphan claim re-pointed
Claims processor
CLM-401024 → UHC-64353-07 (Russell Burton)
Member id
UHC-64353-07
Confidence
1
Method
probabilistic
MBR-004777CLM-401024
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003974
Orphan claim re-pointed
Claims processor
CLM-432672 → UHC-22737-23 (Tricia Turner)
Member id
UHC-22737-23
Confidence
0.93
Method
probabilistic
MBR-005255CLM-432672
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003975
Orphan claim re-pointed
Claims processor
CLM-402944 → UHC-71586-40 (Aisha Morales)
Member id
UHC-71586-40
Confidence
1
Method
probabilistic
MBR-041379CLM-402944
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003976
Orphan claim re-pointed
Claims processor
CLM-414794 → UHC-40403-01 (Scott Ward)
Member id
UHC-40403-01
Confidence
1
Method
probabilistic
MBR-005999CLM-414794
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003977
Orphan claim re-pointed
Claims processor
CLM-411143 → UHC-93282-35 (Brian Powell)
Member id
UHC-93282-35
Confidence
0.99
Method
probabilistic
MBR-026518CLM-411143
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003978
Orphan claim re-pointed
Claims processor
CLM-418528 → UHC-44618-91 (Larry Bailey)
Member id
UHC-44618-91
Confidence
1
Method
probabilistic
MBR-033449CLM-418528
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003979
Orphan claim re-pointed
Claims processor
CLM-422274 → UHC-90765-54 (James Hanson)
Member id
UHC-90765-54
Confidence
0.97
Method
deterministic
MBR-005594CLM-422274
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003980
Orphan claim re-pointed
Claims processor
CLM-432494 → UHC-82771-64 (Rachel Carter)
Member id
UHC-82771-64
Confidence
1
Method
probabilistic
MBR-003657CLM-432494
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003981
Orphan claim re-pointed
Claims processor
CLM-426747 → UHC-83173-41 (Russell Marshall)
Member id
UHC-83173-41
Confidence
1.00
Method
probabilistic
MBR-009113CLM-426747
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003982
Orphan claim re-pointed
Claims processor
CLM-407244 → UHC-89997-70 (Deborah Jackson)
Member id
UHC-89997-70
Confidence
0.94
Method
probabilistic
MBR-015899CLM-407244
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003983
Orphan claim re-pointed
Claims processor
CLM-423021 → UHC-29418-35 (Hannah Bailey)
Member id
UHC-29418-35
Confidence
1
Method
probabilistic
MBR-017918CLM-423021
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003984
Orphan claim re-pointed
Claims processor
CLM-426282 → UHC-83107-81 (Nathan Crawford)
Member id
UHC-83107-81
Confidence
1
Method
probabilistic
MBR-005000CLM-426282
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003985
Orphan claim re-pointed
Claims processor
CLM-410512 → UHC-30571-89 (Brandon Sandoval)
Member id
UHC-30571-89
Confidence
0.99
Method
probabilistic
MBR-006250CLM-410512
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003986
Orphan claim re-pointed
Claims processor
CLM-422261 → UHC-15358-31 (Omar Obrien)
Member id
UHC-15358-31
Confidence
0.99
Method
probabilistic
MBR-023172CLM-422261
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003987
Orphan claim re-pointed
Claims processor
CLM-403579 → UHC-92434-45 (Brittany Cruz)
Member id
UHC-92434-45
Confidence
1
Method
probabilistic
MBR-035717CLM-403579
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003988
Orphan claim re-pointed
Claims processor
CLM-415587 → UHC-81725-26 (Ralph Knight)
Member id
UHC-81725-26
Confidence
0.97
Method
deterministic
MBR-001575CLM-415587
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003989
Orphan claim re-pointed
Claims processor
CLM-430455 → UHC-05137-74 (Ralph Phillips)
Member id
UHC-05137-74
Confidence
1
Method
probabilistic
MBR-001340CLM-430455
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 53 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.