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-004240
Orphan claim re-pointed
Claims processor
CLM-427619 → UHC-49651-19 (Sarah Flores)
Member id
UHC-49651-19
Confidence
0.98
Method
probabilistic
MBR-000553CLM-427619
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004241
Orphan claim re-pointed
Claims processor
CLM-403264 → UHC-51402-46 (Logan Estrada)
Member id
UHC-51402-46
Confidence
0.97
Method
deterministic
MBR-005152CLM-403264
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004242
Orphan claim re-pointed
Claims processor
CLM-425399 → UHC-43649-73 (Isabella Lee)
Member id
UHC-43649-73
Confidence
1
Method
probabilistic
MBR-005074CLM-425399
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004243
Orphan claim re-pointed
Claims processor
CLM-413623 → UHC-21997-61 (Eric Sullivan)
Member id
UHC-21997-61
Confidence
1
Method
probabilistic
MBR-010955CLM-413623
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004244
Orphan claim re-pointed
Claims processor
CLM-404717 → UHC-27674-38 (Sam Johnston)
Member id
UHC-27674-38
Confidence
1
Method
probabilistic
MBR-000742CLM-404717
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004245
Orphan claim re-pointed
Claims processor
CLM-427835 → UHC-81335-37 (Roger Robertson)
Member id
UHC-81335-37
Confidence
0.97
Method
deterministic
MBR-000982CLM-427835
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004246
Orphan claim re-pointed
Claims processor
CLM-414226 → UHC-91421-44 (Patrick Evans)
Member id
UHC-91421-44
Confidence
1
Method
probabilistic
MBR-010246CLM-414226
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004247
Orphan claim re-pointed
Claims processor
CLM-410033 → UHC-91418-45 (Betty Ellis)
Member id
UHC-91418-45
Confidence
0.97
Method
deterministic
MBR-002195CLM-410033
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004248
Orphan claim re-pointed
Claims processor
CLM-418132 → UHC-68518-93 (Megan Crawford)
Member id
UHC-68518-93
Confidence
1
Method
probabilistic
MBR-020175CLM-418132
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004249
Orphan claim re-pointed
Claims processor
CLM-410620 → UHC-53509-62 (Paul Burke)
Member id
UHC-53509-62
Confidence
1
Method
probabilistic
MBR-014690CLM-410620
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004250
Orphan claim re-pointed
Claims processor
CLM-424917 → UHC-29460-03 (Jack Padilla)
Member id
UHC-29460-03
Confidence
0.97
Method
deterministic
MBR-007138CLM-424917
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004251
Orphan claim re-pointed
Claims processor
CLM-413303 → UHC-20506-45 (Teresa Ford)
Member id
UHC-20506-45
Confidence
1
Method
probabilistic
MBR-015307CLM-413303
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004252
Orphan claim re-pointed
Claims processor
CLM-430914 → UHC-43468-04 (Justin Le)
Member id
UHC-43468-04
Confidence
1
Method
probabilistic
MBR-003225CLM-430914
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004253
Orphan claim re-pointed
Claims processor
CLM-421986 → UHC-59702-59 (Kathleen Harrison)
Member id
UHC-59702-59
Confidence
0.97
Method
deterministic
MBR-030150CLM-421986
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004254
Orphan claim re-pointed
Claims processor
CLM-407131 → UHC-93569-57 (Bradley Weaver)
Member id
UHC-93569-57
Confidence
1
Method
probabilistic
MBR-001971CLM-407131
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004255
Orphan claim re-pointed
Claims processor
CLM-413898 → UHC-71588-63 (Mason Vasquez)
Member id
UHC-71588-63
Confidence
0.99
Method
probabilistic
MBR-004843CLM-413898
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004256
Orphan claim re-pointed
Claims processor
CLM-421541 → UHC-53327-52 (Frances Ruiz)
Member id
UHC-53327-52
Confidence
1
Method
probabilistic
MBR-005179CLM-421541
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004257
Orphan claim re-pointed
Claims processor
CLM-427751 → UHC-31521-24 (Melissa Simmons)
Member id
UHC-31521-24
Confidence
1
Method
probabilistic
MBR-016281CLM-427751
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004258
Orphan claim re-pointed
Claims processor
CLM-430855 → UHC-32148-92 (Russell Brooks)
Member id
UHC-32148-92
Confidence
1
Method
probabilistic
MBR-014160CLM-430855
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004259
Orphan claim re-pointed
Claims processor
CLM-423283 → UHC-16726-86 (Elijah Medina)
Member id
UHC-16726-86
Confidence
0.97
Method
deterministic
MBR-039701CLM-423283
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004260
Orphan claim re-pointed
Claims processor
CLM-421724 → UHC-75179-24 (Janice Walsh)
Member id
UHC-75179-24
Confidence
0.97
Method
deterministic
MBR-028171CLM-421724
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004261
Orphan claim re-pointed
Claims processor
CLM-422287 → UHC-73620-42 (Martha Parker)
Member id
UHC-73620-42
Confidence
1
Method
probabilistic
MBR-004211CLM-422287
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004262
Orphan claim re-pointed
Claims processor
CLM-427937 → UHC-95217-49 (Amber Guerrero)
Member id
UHC-95217-49
Confidence
1
Method
probabilistic
MBR-011772CLM-427937
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004263
Orphan claim re-pointed
Claims processor
CLM-427452 → UHC-34576-96 (Kathryn Hart)
Member id
UHC-34576-96
Confidence
1
Method
probabilistic
MBR-016707CLM-427452
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004264
Orphan claim re-pointed
Claims processor
CLM-418308 → UHC-60111-50 (Ethan Kennedy)
Member id
UHC-60111-50
Confidence
1
Method
probabilistic
MBR-024699CLM-418308
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004265
Orphan claim re-pointed
Claims processor
CLM-411184 → UHC-81903-21 (Kelly Obrien)
Member id
UHC-81903-21
Confidence
1
Method
probabilistic
MBR-036431CLM-411184
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004266
Orphan claim re-pointed
Claims processor
CLM-407311 → UHC-06864-83 (Christopher Cooper)
Member id
UHC-06864-83
Confidence
0.93
Method
probabilistic
MBR-025349CLM-407311
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004267
Orphan claim re-pointed
Claims processor
CLM-424089 → UHC-20855-62 (Jack Franklin)
Member id
UHC-20855-62
Confidence
1
Method
probabilistic
MBR-021297CLM-424089
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004268
Orphan claim re-pointed
Claims processor
CLM-404074 → UHC-11337-61 (Austin Rodriguez)
Member id
UHC-11337-61
Confidence
0.97
Method
deterministic
MBR-001213CLM-404074
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004269
Orphan claim re-pointed
Claims processor
CLM-419995 → UHC-55489-25 (Debra Coleman)
Member id
UHC-55489-25
Confidence
0.98
Method
probabilistic
MBR-007999CLM-419995
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004270
Orphan claim re-pointed
Claims processor
CLM-416209 → UHC-90213-48 (Barbara Harris)
Member id
UHC-90213-48
Confidence
1
Method
probabilistic
MBR-022984CLM-416209
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004271
Orphan claim re-pointed
Claims processor
CLM-410641 → UHC-71519-79 (Benjamin Tran)
Member id
UHC-71519-79
Confidence
0.98
Method
probabilistic
MBR-038436CLM-410641
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004272
Orphan claim re-pointed
Claims processor
CLM-419323 → UHC-96694-67 (Victoria Ellis)
Member id
UHC-96694-67
Confidence
1
Method
probabilistic
MBR-000208CLM-419323
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004273
Orphan claim re-pointed
Claims processor
CLM-401953 → UHC-19536-68 (Justin Cooper)
Member id
UHC-19536-68
Confidence
0.97
Method
deterministic
MBR-014103CLM-401953
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004274
Orphan claim re-pointed
Claims processor
CLM-404431 → UHC-89708-54 (Jonathan Turner)
Member id
UHC-89708-54
Confidence
0.90
Method
probabilistic
MBR-012906CLM-404431
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004275
Orphan claim re-pointed
Claims processor
CLM-423164 → UHC-69639-21 (Austin Cox)
Member id
UHC-69639-21
Confidence
1
Method
probabilistic
MBR-028150CLM-423164
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004276
Orphan claim re-pointed
Claims processor
CLM-413496 → UHC-85408-43 (Logan Scott)
Member id
UHC-85408-43
Confidence
0.99
Method
probabilistic
MBR-010107CLM-413496
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004277
Orphan claim re-pointed
Claims processor
CLM-421107 → UHC-17765-89 (Dennis Park)
Member id
UHC-17765-89
Confidence
1
Method
probabilistic
MBR-003350CLM-421107
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004278
Orphan claim re-pointed
Claims processor
CLM-432574 → UHC-89184-93 (Stephen West)
Member id
UHC-89184-93
Confidence
1
Method
probabilistic
MBR-012328CLM-432574
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004279
Orphan claim re-pointed
Claims processor
CLM-417532 → UHC-30073-49 (Jeffrey Singh)
Member id
UHC-30073-49
Confidence
1
Method
probabilistic
MBR-015868CLM-417532
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004280
Orphan claim re-pointed
Claims processor
CLM-418725 → UHC-36257-71 (Ann Garrett)
Member id
UHC-36257-71
Confidence
1
Method
probabilistic
MBR-005663CLM-418725
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004281
Orphan claim re-pointed
Claims processor
CLM-415233 → UHC-06757-59 (Betty Walsh)
Member id
UHC-06757-59
Confidence
1
Method
probabilistic
MBR-003847CLM-415233
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004282
Orphan claim re-pointed
Claims processor
CLM-429107 → UHC-54344-81 (John Wood)
Member id
UHC-54344-81
Confidence
1
Method
probabilistic
MBR-022348CLM-429107
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004283
Orphan claim re-pointed
Claims processor
CLM-410037 → UHC-92120-58 (Joan Clark)
Member id
UHC-92120-58
Confidence
1
Method
probabilistic
MBR-020288CLM-410037
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004284
Orphan claim re-pointed
Claims processor
CLM-400825 → UHC-65773-86 (Victoria Jensen)
Member id
UHC-65773-86
Confidence
0.97
Method
deterministic
MBR-036962CLM-400825
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004285
Orphan claim re-pointed
Claims processor
CLM-422547 → UHC-02051-22 (Pamela Tran)
Member id
UHC-02051-22
Confidence
1
Method
probabilistic
MBR-001502CLM-422547
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004286
Orphan claim re-pointed
Claims processor
CLM-405953 → UHC-04052-21 (Carlos Salazar)
Member id
UHC-04052-21
Confidence
1
Method
probabilistic
MBR-003032CLM-405953
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004287
Orphan claim re-pointed
Claims processor
CLM-425691 → UHC-86595-66 (Mei Maldonado)
Member id
UHC-86595-66
Confidence
1
Method
probabilistic
MBR-026852CLM-425691
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004288
Orphan claim re-pointed
Claims processor
CLM-426137 → UHC-68860-90 (Megan Stewart)
Member id
UHC-68860-90
Confidence
0.97
Method
deterministic
MBR-006251CLM-426137
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004289
Orphan claim re-pointed
Claims processor
CLM-432424 → UHC-20068-10 (Ronald Harrison)
Member id
UHC-20068-10
Confidence
1
Method
probabilistic
MBR-017535CLM-432424
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 59 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.