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-004340
Orphan claim re-pointed
Claims processor
CLM-423691 → UHC-53868-27 (Deborah Henderson)
Member id
UHC-53868-27
Confidence
1
Method
probabilistic
MBR-010482CLM-423691
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004341
Orphan claim re-pointed
Claims processor
CLM-430853 → UHC-82158-14 (Arthur Reid)
Member id
UHC-82158-14
Confidence
1
Method
probabilistic
MBR-020018CLM-430853
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004342
Orphan claim re-pointed
Claims processor
CLM-412834 → UHC-48987-35 (William Black)
Member id
UHC-48987-35
Confidence
1
Method
probabilistic
MBR-012887CLM-412834
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004343
Orphan claim re-pointed
Claims processor
CLM-402736 → UHC-99424-41 (Steven Ortiz)
Member id
UHC-99424-41
Confidence
1
Method
probabilistic
MBR-037021CLM-402736
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004344
Orphan claim re-pointed
Claims processor
CLM-429613 → UHC-73897-98 (Mason Carlson)
Member id
UHC-73897-98
Confidence
0.97
Method
deterministic
MBR-021453CLM-429613
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004345
Orphan claim re-pointed
Claims processor
CLM-401780 → UHC-56523-95 (Brenda Hoffman)
Member id
UHC-56523-95
Confidence
0.97
Method
deterministic
MBR-000853CLM-401780
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004346
Orphan claim re-pointed
Claims processor
CLM-408292 → UHC-68070-58 (Jesse Silva)
Member id
UHC-68070-58
Confidence
0.97
Method
deterministic
MBR-041819CLM-408292
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004347
Orphan claim re-pointed
Claims processor
CLM-425900 → UHC-29387-63 (Ashley Castro)
Member id
UHC-29387-63
Confidence
0.93
Method
probabilistic
MBR-021612CLM-425900
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004348
Orphan claim re-pointed
Claims processor
CLM-428241 → UHC-07325-19 (Owens Kyle)
Member id
UHC-07325-19
Confidence
0.99
Method
probabilistic
MBR-015989CLM-428241
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004349
Orphan claim re-pointed
Claims processor
CLM-417332 → UHC-33594-46 (Keith Ford)
Member id
UHC-33594-46
Confidence
1
Method
probabilistic
MBR-003874CLM-417332
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004350
Orphan claim re-pointed
Claims processor
CLM-426376 → UHC-99425-15 (Megan Pena)
Member id
UHC-99425-15
Confidence
1
Method
probabilistic
MBR-009040CLM-426376
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004351
Orphan claim re-pointed
Claims processor
CLM-429755 → UHC-77817-38 (Ahmed Campbell)
Member id
UHC-77817-38
Confidence
1
Method
probabilistic
MBR-005854CLM-429755
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004352
Orphan claim re-pointed
Claims processor
CLM-424384 → UHC-83825-17 (Steven Campbell)
Member id
UHC-83825-17
Confidence
0.99
Method
probabilistic
MBR-007537CLM-424384
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004353
Orphan claim re-pointed
Claims processor
CLM-430450 → UHC-56379-27 (Henry Riley)
Member id
UHC-56379-27
Confidence
1
Method
probabilistic
MBR-019567CLM-430450
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004354
Orphan claim re-pointed
Claims processor
CLM-418418 → UHC-53311-49 (Henry Wells)
Member id
UHC-53311-49
Confidence
1
Method
probabilistic
MBR-035489CLM-418418
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004355
Orphan claim re-pointed
Claims processor
CLM-415505 → UHC-91983-24 (Debra Stone)
Member id
UHC-91983-24
Confidence
1
Method
probabilistic
MBR-006307CLM-415505
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004356
Orphan claim re-pointed
Claims processor
CLM-412850 → UHC-38547-86 (Kathleen Butler)
Member id
UHC-38547-86
Confidence
1
Method
probabilistic
MBR-009402CLM-412850
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004357
Orphan claim re-pointed
Claims processor
CLM-401402 → UHC-65311-64 (Gabriel Robertson)
Member id
UHC-65311-64
Confidence
0.97
Method
deterministic
MBR-001760CLM-401402
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004358
Orphan claim re-pointed
Claims processor
CLM-410769 → UHC-22956-92 (Ahmed Soto)
Member id
UHC-22956-92
Confidence
0.97
Method
deterministic
MBR-020636CLM-410769
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004359
Orphan claim re-pointed
Claims processor
CLM-406434 → UHC-47879-82 (Philip Bradley)
Member id
UHC-47879-82
Confidence
0.97
Method
deterministic
MBR-009392CLM-406434
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004360
Orphan claim re-pointed
Claims processor
CLM-424952 → UHC-53327-82 (Joan Garcia)
Member id
UHC-53327-82
Confidence
1
Method
probabilistic
MBR-026315CLM-424952
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004361
Orphan claim re-pointed
Claims processor
CLM-428331 → UHC-32024-80 (Gary Schultz)
Member id
UHC-32024-80
Confidence
0.99
Method
probabilistic
MBR-015320CLM-428331
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004362
Orphan claim re-pointed
Claims processor
CLM-420615 → UHC-70265-57 (Sandra Bell)
Member id
UHC-70265-57
Confidence
0.97
Method
deterministic
MBR-015249CLM-420615
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004363
Orphan claim re-pointed
Claims processor
CLM-410809 → UHC-06257-82 (Nicole Richardson)
Member id
UHC-06257-82
Confidence
1
Method
probabilistic
MBR-001810CLM-410809
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004364
Orphan claim re-pointed
Claims processor
CLM-405577 → UHC-79801-51 (Aaron Cruz)
Member id
UHC-79801-51
Confidence
1
Method
probabilistic
MBR-001084CLM-405577
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004365
Orphan claim re-pointed
Claims processor
CLM-420795 → UHC-91720-52 (Aaron Pierce)
Member id
UHC-91720-52
Confidence
1
Method
probabilistic
MBR-006931CLM-420795
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004366
Orphan claim re-pointed
Claims processor
CLM-402438 → UHC-00799-30 (Billy Armstrong)
Member id
UHC-00799-30
Confidence
1
Method
probabilistic
MBR-008972CLM-402438
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004367
Orphan claim re-pointed
Claims processor
CLM-405462 → UHC-90340-61 (Jessica Alexander)
Member id
UHC-90340-61
Confidence
1.00
Method
probabilistic
MBR-009061CLM-405462
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004368
Orphan claim re-pointed
Claims processor
CLM-432468 → UHC-22050-94 (Donald Simpson)
Member id
UHC-22050-94
Confidence
1
Method
probabilistic
MBR-008385CLM-432468
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004369
Orphan claim re-pointed
Claims processor
CLM-425783 → UHC-18122-45 (Philip Graham)
Member id
UHC-18122-45
Confidence
1
Method
probabilistic
MBR-014474CLM-425783
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004370
Orphan claim re-pointed
Claims processor
CLM-405684 → UHC-36039-09 (Nancy Soto)
Member id
UHC-36039-09
Confidence
1
Method
probabilistic
MBR-010941CLM-405684
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004371
Orphan claim re-pointed
Claims processor
CLM-412080 → UHC-44248-84 (Greg Moreno)
Member id
UHC-44248-84
Confidence
1
Method
probabilistic
MBR-037864CLM-412080
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004372
Orphan claim re-pointed
Claims processor
CLM-402392 → UHC-86655-79 (Carl Morales)
Member id
UHC-86655-79
Confidence
0.99
Method
probabilistic
MBR-017157CLM-402392
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004373
Orphan claim re-pointed
Claims processor
CLM-418352 → UHC-74847-84 (Bobby Wright)
Member id
UHC-74847-84
Confidence
1
Method
probabilistic
MBR-005523CLM-418352
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004374
Orphan claim re-pointed
Claims processor
CLM-404881 → UHC-28782-70 (Kayla Williamson)
Member id
UHC-28782-70
Confidence
1
Method
probabilistic
MBR-005574CLM-404881
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004375
Orphan claim re-pointed
Claims processor
CLM-400997 → UHC-22655-79 (Diane Washington)
Member id
UHC-22655-79
Confidence
0.99
Method
probabilistic
MBR-003213CLM-400997
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004376
Orphan claim re-pointed
Claims processor
CLM-429215 → UHC-51289-46 (Christine Vega)
Member id
UHC-51289-46
Confidence
1
Method
probabilistic
MBR-007977CLM-429215
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004377
Orphan claim re-pointed
Claims processor
CLM-404216 → UHC-78034-52 (Phiilp Bell)
Member id
UHC-78034-52
Confidence
0.99
Method
probabilistic
MBR-001974CLM-404216
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004378
Orphan claim re-pointed
Claims processor
CLM-403531 → UHC-00007-16 (Megan Davis)
Member id
UHC-00007-16
Confidence
1
Method
probabilistic
MBR-007683CLM-403531
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004379
Orphan claim re-pointed
Claims processor
CLM-407904 → UHC-80744-56 (Tyler Oliver)
Member id
UHC-80744-56
Confidence
1
Method
probabilistic
MBR-010291CLM-407904
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004380
Orphan claim re-pointed
Claims processor
CLM-423645 → UHC-08974-21 (Daniel Lawrence)
Member id
UHC-08974-21
Confidence
0.97
Method
deterministic
MBR-028194CLM-423645
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004381
Orphan claim re-pointed
Claims processor
CLM-420928 → UHC-14343-17 (Theresa Parker)
Member id
UHC-14343-17
Confidence
1
Method
probabilistic
MBR-011124CLM-420928
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004382
Orphan claim re-pointed
Claims processor
CLM-420058 → UHC-22457-29 (Christina Hunter)
Member id
UHC-22457-29
Confidence
1
Method
probabilistic
MBR-025701CLM-420058
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004383
Orphan claim re-pointed
Claims processor
CLM-403515 → UHC-67445-33 (Carlos Perkins)
Member id
UHC-67445-33
Confidence
0.99
Method
probabilistic
MBR-041211CLM-403515
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004384
Orphan claim re-pointed
Claims processor
CLM-404579 → UHC-86611-68 (Amber White)
Member id
UHC-86611-68
Confidence
1
Method
probabilistic
MBR-000307CLM-404579
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004385
Orphan claim re-pointed
Claims processor
CLM-418887 → UHC-49421-70 (Willie Ray)
Member id
UHC-49421-70
Confidence
1
Method
probabilistic
MBR-004824CLM-418887
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004386
Orphan claim re-pointed
Claims processor
CLM-414517 → UHC-95289-30 (Kimberly Cooper)
Member id
UHC-95289-30
Confidence
1
Method
probabilistic
MBR-021961CLM-414517
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004387
Orphan claim re-pointed
Claims processor
CLM-412270 → UHC-62023-76 (David Hansen)
Member id
UHC-62023-76
Confidence
1
Method
probabilistic
MBR-022426CLM-412270
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004388
Orphan claim re-pointed
Claims processor
CLM-401836 → UHC-69471-08 (Cynthia Ray)
Member id
UHC-69471-08
Confidence
1
Method
probabilistic
MBR-016886CLM-401836
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004389
Orphan claim re-pointed
Claims processor
CLM-408033 → UHC-18542-99 (Deborah Freeman)
Member id
UHC-18542-99
Confidence
1.00
Method
probabilistic
MBR-029997CLM-408033
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 61 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.