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-004290
Orphan claim re-pointed
Claims processor
CLM-419881 → UHC-59946-17 (Elizabeth Dunn)
Member id
UHC-59946-17
Confidence
1
Method
probabilistic
MBR-012398CLM-419881
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004291
Orphan claim re-pointed
Claims processor
CLM-416054 → UHC-10195-16 (Brenda Harper)
Member id
UHC-10195-16
Confidence
0.99
Method
probabilistic
MBR-011414CLM-416054
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004292
Orphan claim re-pointed
Claims processor
CLM-414175 → UHC-14239-31 (Ralph Wang)
Member id
UHC-14239-31
Confidence
1
Method
probabilistic
MBR-003499CLM-414175
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004293
Orphan claim re-pointed
Claims processor
CLM-419376 → UHC-85432-06 (Albert Ellis)
Member id
UHC-85432-06
Confidence
1
Method
probabilistic
MBR-005701CLM-419376
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004294
Orphan claim re-pointed
Claims processor
CLM-410428 → UHC-36655-13 (Anna Dunn)
Member id
UHC-36655-13
Confidence
1
Method
probabilistic
MBR-015284CLM-410428
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004295
Orphan claim re-pointed
Claims processor
CLM-425792 → UHC-08978-41 (Sarah Medina)
Member id
UHC-08978-41
Confidence
0.99
Method
probabilistic
MBR-020222CLM-425792
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004296
Orphan claim re-pointed
Claims processor
CLM-425711 → UHC-99938-63 (Ronald Morales)
Member id
UHC-99938-63
Confidence
0.97
Method
deterministic
MBR-001108CLM-425711
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004297
Orphan claim re-pointed
Claims processor
CLM-420179 → UHC-03984-93 (Arthur Espinoza)
Member id
UHC-03984-93
Confidence
1
Method
probabilistic
MBR-001968CLM-420179
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004298
Orphan claim re-pointed
Claims processor
CLM-417454 → UHC-23661-33 (Diana Morales)
Member id
UHC-23661-33
Confidence
1
Method
probabilistic
MBR-012292CLM-417454
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004299
Orphan claim re-pointed
Claims processor
CLM-423148 → UHC-59596-37 (Shirley Fields)
Member id
UHC-59596-37
Confidence
0.97
Method
deterministic
MBR-021044CLM-423148
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004300
Orphan claim re-pointed
Claims processor
CLM-404787 → UHC-59499-59 (Robert Gray)
Member id
UHC-59499-59
Confidence
1
Method
probabilistic
MBR-003407CLM-404787
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004301
Orphan claim re-pointed
Claims processor
CLM-430126 → UHC-80701-58 (Melissa Maldonado)
Member id
UHC-80701-58
Confidence
1
Method
probabilistic
MBR-010141CLM-430126
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004302
Orphan claim re-pointed
Claims processor
CLM-419989 → UHC-75209-77 (Julia Mason)
Member id
UHC-75209-77
Confidence
1
Method
probabilistic
MBR-001973CLM-419989
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004303
Orphan claim re-pointed
Claims processor
CLM-401701 → UHC-95931-01 (John Estrada)
Member id
UHC-95931-01
Confidence
1
Method
probabilistic
MBR-014478CLM-401701
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004304
Orphan claim re-pointed
Claims processor
CLM-420461 → UHC-71408-63 (Patrick Valdez)
Member id
UHC-71408-63
Confidence
1
Method
probabilistic
MBR-000400CLM-420461
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004305
Orphan claim re-pointed
Claims processor
CLM-424648 → UHC-71648-50 (Donna Black)
Member id
UHC-71648-50
Confidence
1
Method
probabilistic
MBR-009068CLM-424648
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004306
Orphan claim re-pointed
Claims processor
CLM-410631 → UHC-93372-22 (Adam Gonzales)
Member id
UHC-93372-22
Confidence
0.97
Method
deterministic
MBR-017777CLM-410631
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004307
Orphan claim re-pointed
Claims processor
CLM-424030 → UHC-69937-12 (Nicole Weber)
Member id
UHC-69937-12
Confidence
1
Method
probabilistic
MBR-027853CLM-424030
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004308
Orphan claim re-pointed
Claims processor
CLM-416948 → UHC-24731-14 (Bradley Sims)
Member id
UHC-24731-14
Confidence
0.97
Method
deterministic
MBR-033055CLM-416948
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004309
Orphan claim re-pointed
Claims processor
CLM-422526 → UHC-31180-51 (Jonh Lynch)
Member id
UHC-31180-51
Confidence
1
Method
probabilistic
MBR-027327CLM-422526
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004310
Orphan claim re-pointed
Claims processor
CLM-406986 → UHC-95867-45 (Mark Hunt)
Member id
UHC-95867-45
Confidence
1
Method
probabilistic
MBR-005463CLM-406986
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004311
Orphan claim re-pointed
Claims processor
CLM-400032 → UHC-33359-92 (Lauren Williams)
Member id
UHC-33359-92
Confidence
1
Method
probabilistic
MBR-005998CLM-400032
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004312
Orphan claim re-pointed
Claims processor
CLM-407613 → UHC-02317-39 (Willie Robinson)
Member id
UHC-02317-39
Confidence
1
Method
probabilistic
MBR-014831CLM-407613
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004313
Orphan claim re-pointed
Claims processor
CLM-426932 → UHC-86886-77 (Brittany Moore)
Member id
UHC-86886-77
Confidence
0.97
Method
deterministic
MBR-037929CLM-426932
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004314
Orphan claim re-pointed
Claims processor
CLM-412000 → UHC-04366-25 (Jesse Pena)
Member id
UHC-04366-25
Confidence
0.91
Method
probabilistic
MBR-013722CLM-412000
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004315
Orphan claim re-pointed
Claims processor
CLM-420634 → UHC-37443-96 (Camila Hart)
Member id
UHC-37443-96
Confidence
1
Method
probabilistic
MBR-010163CLM-420634
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004316
Orphan claim re-pointed
Claims processor
CLM-416541 → UHC-85208-07 (Virginia Watkins)
Member id
UHC-85208-07
Confidence
1.00
Method
probabilistic
MBR-005476CLM-416541
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004317
Orphan claim re-pointed
Claims processor
CLM-403386 → UHC-58157-12 (Mergaret Daniels)
Member id
UHC-58157-12
Confidence
0.97
Method
deterministic
MBR-027902CLM-403386
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004318
Orphan claim re-pointed
Claims processor
CLM-430984 → UHC-12148-09 (Arthur Marshall)
Member id
UHC-12148-09
Confidence
0.97
Method
deterministic
MBR-003557CLM-430984
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004319
Orphan claim re-pointed
Claims processor
CLM-400454 → UHC-32643-30 (Nicole Chen)
Member id
UHC-32643-30
Confidence
1
Method
probabilistic
MBR-024627CLM-400454
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004320
Orphan claim re-pointed
Claims processor
CLM-409241 → UHC-53081-01 (Brian Contreras)
Member id
UHC-53081-01
Confidence
1
Method
probabilistic
MBR-005966CLM-409241
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004321
Orphan claim re-pointed
Claims processor
CLM-412162 → UHC-63588-98 (Deborah Harper)
Member id
UHC-63588-98
Confidence
1
Method
probabilistic
MBR-015621CLM-412162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004322
Orphan claim re-pointed
Claims processor
CLM-413605 → UHC-67536-71 (Kevin Price)
Member id
UHC-67536-71
Confidence
1
Method
probabilistic
MBR-022492CLM-413605
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004323
Orphan claim re-pointed
Claims processor
CLM-407812 → UHC-14541-33 (Keith Alvarez)
Member id
UHC-14541-33
Confidence
1
Method
probabilistic
MBR-024584CLM-407812
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004324
Orphan claim re-pointed
Claims processor
CLM-425992 → UHC-41776-91 (Theesa Cunningham)
Member id
UHC-41776-91
Confidence
0.99
Method
probabilistic
MBR-028413CLM-425992
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004325
Orphan claim re-pointed
Claims processor
CLM-420107 → UHC-26490-13 (Sophia Vasquez)
Member id
UHC-26490-13
Confidence
1
Method
probabilistic
MBR-035701CLM-420107
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004326
Orphan claim re-pointed
Claims processor
CLM-420669 → UHC-83875-27 (Roy Butler)
Member id
UHC-83875-27
Confidence
0.93
Method
probabilistic
MBR-036432CLM-420669
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004327
Orphan claim re-pointed
Claims processor
CLM-407969 → UHC-78349-47 (Samantha Weaver)
Member id
UHC-78349-47
Confidence
1
Method
probabilistic
MBR-043803CLM-407969
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004328
Orphan claim re-pointed
Claims processor
CLM-411441 → UHC-39705-70 (Jean Ramos)
Member id
UHC-39705-70
Confidence
1
Method
probabilistic
MBR-036910CLM-411441
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004329
Orphan claim re-pointed
Claims processor
CLM-430987 → UHC-36502-86 (Julie Guerrero)
Member id
UHC-36502-86
Confidence
1
Method
probabilistic
MBR-014452CLM-430987
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004330
Orphan claim re-pointed
Claims processor
CLM-400271 → UHC-25022-82 (Kenneth Reynolds)
Member id
UHC-25022-82
Confidence
0.97
Method
deterministic
MBR-006118CLM-400271
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004331
Orphan claim re-pointed
Claims processor
CLM-432819 → UHC-49764-58 (Virginia Guerrero)
Member id
UHC-49764-58
Confidence
1
Method
probabilistic
MBR-001633CLM-432819
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004332
Orphan claim re-pointed
Claims processor
CLM-422480 → UHC-68384-52 (Zachary George)
Member id
UHC-68384-52
Confidence
0.98
Method
probabilistic
MBR-014190CLM-422480
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004333
Orphan claim re-pointed
Claims processor
CLM-426564 → UHC-71994-41 (Paul Luna)
Member id
UHC-71994-41
Confidence
1
Method
probabilistic
MBR-043448CLM-426564
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004334
Orphan claim re-pointed
Claims processor
CLM-403262 → UHC-56221-72 (Jesse Morrison)
Member id
UHC-56221-72
Confidence
1
Method
probabilistic
MBR-001092CLM-403262
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004335
Orphan claim re-pointed
Claims processor
CLM-408262 → UHC-46355-36 (Jerry Kelley)
Member id
UHC-46355-36
Confidence
0.97
Method
deterministic
MBR-027290CLM-408262
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004336
Orphan claim re-pointed
Claims processor
CLM-420830 → UHC-35561-40 (Sean Chapman)
Member id
UHC-35561-40
Confidence
1
Method
probabilistic
MBR-028421CLM-420830
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004337
Orphan claim re-pointed
Claims processor
CLM-429661 → UHC-37303-77 (Christine Moore)
Member id
UHC-37303-77
Confidence
1
Method
probabilistic
MBR-003462CLM-429661
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004338
Orphan claim re-pointed
Claims processor
CLM-410566 → UHC-81084-47 (Christine Gonzales)
Member id
UHC-81084-47
Confidence
0.97
Method
deterministic
MBR-007458CLM-410566
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004339
Orphan claim re-pointed
Claims processor
CLM-430502 → UHC-98619-77 (Pamela Guzman)
Member id
UHC-98619-77
Confidence
1
Method
probabilistic
MBR-020086CLM-430502
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 60 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.