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-003990
Orphan claim re-pointed
Claims processor
CLM-431427 → UHC-22728-58 (Frances Gonzalez)
Member id
UHC-22728-58
Confidence
1
Method
probabilistic
MBR-018423CLM-431427
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003991
Orphan claim re-pointed
Claims processor
CLM-429410 → UHC-13009-12 (Raymond Day)
Member id
UHC-13009-12
Confidence
0.97
Method
deterministic
MBR-021516CLM-429410
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003992
Orphan claim re-pointed
Claims processor
CLM-431907 → UHC-49229-90 (Melissa Hudson)
Member id
UHC-49229-90
Confidence
1
Method
probabilistic
MBR-015560CLM-431907
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003993
Orphan claim re-pointed
Claims processor
CLM-424372 → UHC-51097-26 (Roger Sanders)
Member id
UHC-51097-26
Confidence
1
Method
probabilistic
MBR-007736CLM-424372
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003994
Orphan claim re-pointed
Claims processor
CLM-402931 → UHC-11323-44 (Gregory Morales)
Member id
UHC-11323-44
Confidence
1
Method
probabilistic
MBR-009727CLM-402931
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003995
Orphan claim re-pointed
Claims processor
CLM-413706 → UHC-85465-78 (Beverly Ruiz)
Member id
UHC-85465-78
Confidence
1
Method
probabilistic
MBR-034490CLM-413706
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003996
Orphan claim re-pointed
Claims processor
CLM-400645 → UHC-12852-84 (Willie Walsh)
Member id
UHC-12852-84
Confidence
1
Method
probabilistic
MBR-004666CLM-400645
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003997
Orphan claim re-pointed
Claims processor
CLM-414426 → UHC-58675-91 (Aisha Ryan)
Member id
UHC-58675-91
Confidence
0.98
Method
probabilistic
MBR-001604CLM-414426
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003998
Orphan claim re-pointed
Claims processor
CLM-411076 → UHC-47519-53 (Robert Stevens)
Member id
UHC-47519-53
Confidence
1
Method
probabilistic
MBR-012694CLM-411076
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003999
Orphan claim re-pointed
Claims processor
CLM-420610 → UHC-72345-89 (Albert Ramos)
Member id
UHC-72345-89
Confidence
1
Method
probabilistic
MBR-002204CLM-420610
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004000
Orphan claim re-pointed
Claims processor
CLM-426919 → UHC-33271-88 (Omar Li)
Member id
UHC-33271-88
Confidence
1
Method
probabilistic
MBR-022335CLM-426919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004001
Orphan claim re-pointed
Claims processor
CLM-419896 → UHC-02823-72 (Susan Bradley)
Member id
UHC-02823-72
Confidence
1
Method
probabilistic
MBR-003031CLM-419896
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004002
Orphan claim re-pointed
Claims processor
CLM-418563 → UHC-01130-29 (Sean Adams)
Member id
UHC-01130-29
Confidence
1
Method
probabilistic
MBR-012351CLM-418563
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004003
Orphan claim re-pointed
Claims processor
CLM-422127 → UHC-48770-09 (Mary Walker)
Member id
UHC-48770-09
Confidence
0.97
Method
deterministic
MBR-020397CLM-422127
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004004
Orphan claim re-pointed
Claims processor
CLM-422264 → UHC-48770-91 (Marilyn Taylor)
Member id
UHC-48770-91
Confidence
0.94
Method
probabilistic
MBR-039170CLM-422264
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004005
Orphan claim re-pointed
Claims processor
CLM-429391 → UHC-42496-47 (Emily Roberts)
Member id
UHC-42496-47
Confidence
1
Method
probabilistic
MBR-000251CLM-429391
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004006
Orphan claim re-pointed
Claims processor
CLM-404606 → UHC-76091-41 (Susan Kennedy)
Member id
UHC-76091-41
Confidence
1
Method
probabilistic
MBR-006593CLM-404606
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004007
Orphan claim re-pointed
Claims processor
CLM-426374 → UHC-10097-24 (Sharon Salazar)
Member id
UHC-10097-24
Confidence
1
Method
probabilistic
MBR-021868CLM-426374
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004008
Orphan claim re-pointed
Claims processor
CLM-412987 → UHC-79196-55 (Olivia Washington)
Member id
UHC-79196-55
Confidence
0.93
Method
probabilistic
MBR-019629CLM-412987
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004009
Orphan claim re-pointed
Claims processor
CLM-407441 → UHC-50936-17 (Evalyn Burke)
Member id
UHC-50936-17
Confidence
0.97
Method
deterministic
MBR-008809CLM-407441
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004010
Orphan claim re-pointed
Claims processor
CLM-422123 → UHC-31111-49 (Sara Estrada)
Member id
UHC-31111-49
Confidence
1
Method
probabilistic
MBR-025408CLM-422123
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004011
Orphan claim re-pointed
Claims processor
CLM-408876 → UHC-41515-84 (Bruce Perkins)
Member id
UHC-41515-84
Confidence
1
Method
probabilistic
MBR-032349CLM-408876
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004012
Orphan claim re-pointed
Claims processor
CLM-413701 → UHC-94110-47 (Vincent Ruiz)
Member id
UHC-94110-47
Confidence
1
Method
probabilistic
MBR-019601CLM-413701
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004013
Orphan claim re-pointed
Claims processor
CLM-425529 → UHC-34433-48 (Scott Johnston)
Member id
UHC-34433-48
Confidence
1
Method
probabilistic
MBR-006216CLM-425529
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004014
Orphan claim re-pointed
Claims processor
CLM-423304 → UHC-41301-41 (Arjun Scott)
Member id
UHC-41301-41
Confidence
1
Method
probabilistic
MBR-013677CLM-423304
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004015
Orphan claim re-pointed
Claims processor
CLM-415077 → UHC-59750-05 (Mariana Robertson)
Member id
UHC-59750-05
Confidence
1
Method
probabilistic
MBR-014889CLM-415077
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004016
Orphan claim re-pointed
Claims processor
CLM-414590 → UHC-07734-45 (Larry Franklin)
Member id
UHC-07734-45
Confidence
0.97
Method
deterministic
MBR-007267CLM-414590
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004017
Orphan claim re-pointed
Claims processor
CLM-403125 → UHC-84056-95 (Nicholas Carter)
Member id
UHC-84056-95
Confidence
1
Method
probabilistic
MBR-015183CLM-403125
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004018
Orphan claim re-pointed
Claims processor
CLM-417283 → UHC-25481-39 (Robert Jacobs)
Member id
UHC-25481-39
Confidence
1
Method
probabilistic
MBR-018340CLM-417283
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004019
Orphan claim re-pointed
Claims processor
CLM-418059 → UHC-48631-14 (Dorothy Austin)
Member id
UHC-48631-14
Confidence
1
Method
probabilistic
MBR-006487CLM-418059
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004020
Orphan claim re-pointed
Claims processor
CLM-403178 → UHC-09651-87 (Joe Stephens)
Member id
UHC-09651-87
Confidence
1
Method
probabilistic
MBR-035777CLM-403178
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004021
Orphan claim re-pointed
Claims processor
CLM-418104 → UHC-19280-61 (Billy Vega)
Member id
UHC-19280-61
Confidence
0.97
Method
deterministic
MBR-007483CLM-418104
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004022
Orphan claim re-pointed
Claims processor
CLM-418142 → UHC-70156-56 (Alexis Ortega)
Member id
UHC-70156-56
Confidence
1
Method
probabilistic
MBR-005764CLM-418142
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004023
Orphan claim re-pointed
Claims processor
CLM-407133 → UHC-67835-89 (Sofia Thomas)
Member id
UHC-67835-89
Confidence
1
Method
probabilistic
MBR-018381CLM-407133
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004024
Orphan claim re-pointed
Claims processor
CLM-414582 → UHC-59640-98 (Angela Munoz)
Member id
UHC-59640-98
Confidence
0.97
Method
deterministic
MBR-011856CLM-414582
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004025
Orphan claim re-pointed
Claims processor
CLM-429758 → UHC-12907-68 (Betty Henderson)
Member id
UHC-12907-68
Confidence
1
Method
probabilistic
MBR-017920CLM-429758
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004026
Orphan claim re-pointed
Claims processor
CLM-413512 → UHC-68644-16 (Mary Jacobs)
Member id
UHC-68644-16
Confidence
1
Method
probabilistic
MBR-000828CLM-413512
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004027
Orphan claim re-pointed
Claims processor
CLM-429411 → UHC-13009-12 (Raymond Day)
Member id
UHC-13009-12
Confidence
0.97
Method
deterministic
MBR-021516CLM-429411
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004028
Orphan claim re-pointed
Claims processor
CLM-429304 → UHC-72399-15 (Kimberly Boyd)
Member id
UHC-72399-15
Confidence
1
Method
probabilistic
MBR-003776CLM-429304
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004029
Orphan claim re-pointed
Claims processor
CLM-408177 → UHC-31352-78 (Joyce Montgomery)
Member id
UHC-31352-78
Confidence
1
Method
probabilistic
MBR-033608CLM-408177
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004030
Orphan claim re-pointed
Claims processor
CLM-417367 → UHC-17090-46 (Joyce Medina)
Member id
UHC-17090-46
Confidence
1
Method
probabilistic
MBR-019930CLM-417367
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004031
Orphan claim re-pointed
Claims processor
CLM-423822 → UHC-86408-56 (Larry Reed)
Member id
UHC-86408-56
Confidence
0.97
Method
deterministic
MBR-017870CLM-423822
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004032
Orphan claim re-pointed
Claims processor
CLM-425417 → UHC-09047-81 (Samantha Palmer)
Member id
UHC-09047-81
Confidence
0.93
Method
probabilistic
MBR-014063CLM-425417
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004033
Orphan claim re-pointed
Claims processor
CLM-412062 → UHC-08393-09 (Emily Schultz)
Member id
UHC-08393-09
Confidence
0.92
Method
probabilistic
MBR-017879CLM-412062
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004034
Orphan claim re-pointed
Claims processor
CLM-424116 → UHC-54403-51 (Frank Lawrence)
Member id
UHC-54403-51
Confidence
1
Method
probabilistic
MBR-008217CLM-424116
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004035
Orphan claim re-pointed
Claims processor
CLM-404589 → UHC-13779-44 (Lawrence Ray)
Member id
UHC-13779-44
Confidence
0.97
Method
deterministic
MBR-007107CLM-404589
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004036
Orphan claim re-pointed
Claims processor
CLM-412553 → UHC-29225-61 (Wayne Rojas)
Member id
UHC-29225-61
Confidence
0.97
Method
deterministic
MBR-001118CLM-412553
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004037
Orphan claim re-pointed
Claims processor
CLM-402612 → UHC-08708-37 (Adam Long)
Member id
UHC-08708-37
Confidence
1
Method
probabilistic
MBR-003153CLM-402612
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004038
Orphan claim re-pointed
Claims processor
CLM-402582 → UHC-09959-89 (Philip Crawford)
Member id
UHC-09959-89
Confidence
1
Method
probabilistic
MBR-036725CLM-402582
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004039
Orphan claim re-pointed
Claims processor
CLM-416624 → UHC-37629-09 (Dennis Vargas)
Member id
UHC-37629-09
Confidence
1
Method
probabilistic
MBR-001650CLM-416624
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 54 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.