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-004440
Orphan claim re-pointed
Claims processor
CLM-427544 → UHC-28198-68 (Marilyn George)
Member id
UHC-28198-68
Confidence
1
Method
probabilistic
MBR-020279CLM-427544
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004441
Orphan claim re-pointed
Claims processor
CLM-409764 → UHC-81594-70 (Heather Carpenter)
Member id
UHC-81594-70
Confidence
1.00
Method
probabilistic
MBR-034299CLM-409764
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004442
Orphan claim re-pointed
Claims processor
CLM-412642 → UHC-66069-07 (Olivia Sanchez)
Member id
UHC-66069-07
Confidence
1
Method
probabilistic
MBR-012318CLM-412642
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004443
Orphan claim re-pointed
Claims processor
CLM-426899 → UHC-76883-32 (Ethan Rogers)
Member id
UHC-76883-32
Confidence
1
Method
probabilistic
MBR-004933CLM-426899
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004444
Orphan claim re-pointed
Claims processor
CLM-407943 → UHC-25891-17 (Jeremy Hill)
Member id
UHC-25891-17
Confidence
0.97
Method
probabilistic
MBR-017345CLM-407943
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004445
Orphan claim re-pointed
Claims processor
CLM-420978 → UHC-04062-47 (Ronald Williamson)
Member id
UHC-04062-47
Confidence
1
Method
probabilistic
MBR-013304CLM-420978
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004446
Orphan claim re-pointed
Claims processor
CLM-404702 → UHC-03406-45 (Joseph Obrien)
Member id
UHC-03406-45
Confidence
0.99
Method
probabilistic
MBR-023190CLM-404702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004447
Orphan claim re-pointed
Claims processor
CLM-416837 → UHC-19314-17 (Terry Gomez)
Member id
UHC-19314-17
Confidence
1
Method
probabilistic
MBR-013807CLM-416837
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004448
Orphan claim re-pointed
Claims processor
CLM-428737 → UHC-38311-79 (Pamela Cooper)
Member id
UHC-38311-79
Confidence
1
Method
probabilistic
MBR-008867CLM-428737
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004449
Orphan claim re-pointed
Claims processor
CLM-401450 → UHC-43441-53 (Melissa Cruz)
Member id
UHC-43441-53
Confidence
1
Method
probabilistic
MBR-017340CLM-401450
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004450
Orphan claim re-pointed
Claims processor
CLM-413585 → UHC-05076-98 (Christian Gonzalez)
Member id
UHC-05076-98
Confidence
1
Method
probabilistic
MBR-013245CLM-413585
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004451
Orphan claim re-pointed
Claims processor
CLM-408300 → UHC-60955-24 (Michelle Jensen)
Member id
UHC-60955-24
Confidence
0.97
Method
deterministic
MBR-016856CLM-408300
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004452
Orphan claim re-pointed
Claims processor
CLM-405625 → UHC-30686-19 (Timothy Howell)
Member id
UHC-30686-19
Confidence
1
Method
probabilistic
MBR-021210CLM-405625
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004453
Orphan claim re-pointed
Claims processor
CLM-407896 → UHC-52556-86 (Dennis Hart)
Member id
UHC-52556-86
Confidence
1
Method
probabilistic
MBR-028046CLM-407896
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004454
Orphan claim re-pointed
Claims processor
CLM-424245 → UHC-43737-02 (Gabriel Freeman)
Member id
UHC-43737-02
Confidence
0.97
Method
deterministic
MBR-012474CLM-424245
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004455
Orphan claim re-pointed
Claims processor
CLM-429232 → UHC-12565-68 (Sofia Alvarez)
Member id
UHC-12565-68
Confidence
0.97
Method
deterministic
MBR-000583CLM-429232
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004456
Orphan claim re-pointed
Claims processor
CLM-425974 → UHC-38228-80 (Tyler Myres)
Member id
UHC-38228-80
Confidence
0.99
Method
probabilistic
MBR-019890CLM-425974
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004457
Orphan claim re-pointed
Claims processor
CLM-416891 → UHC-26251-27 (Natalie Shaw)
Member id
UHC-26251-27
Confidence
0.97
Method
deterministic
MBR-020218CLM-416891
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004458
Orphan claim re-pointed
Claims processor
CLM-415525 → UHC-23280-93 (Philip Garrett)
Member id
UHC-23280-93
Confidence
1
Method
probabilistic
MBR-014246CLM-415525
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004459
Orphan claim re-pointed
Claims processor
CLM-418893 → UHC-58135-07 (Gloria Franklin)
Member id
UHC-58135-07
Confidence
1
Method
probabilistic
MBR-025010CLM-418893
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004460
Orphan claim re-pointed
Claims processor
CLM-427640 → UHC-57924-01 (Shirley Simpson)
Member id
UHC-57924-01
Confidence
1
Method
probabilistic
MBR-017444CLM-427640
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004461
Orphan claim re-pointed
Claims processor
CLM-409688 → UHC-35048-99 (Aaron Taylor)
Member id
UHC-35048-99
Confidence
1
Method
probabilistic
MBR-015068CLM-409688
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004462
Orphan claim re-pointed
Claims processor
CLM-411849 → UHC-83217-83 (Denise Snyder)
Member id
UHC-83217-83
Confidence
0.86
Method
probabilistic
MBR-013388CLM-411849
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004463
Orphan claim re-pointed
Claims processor
CLM-408589 → UHC-00750-76 (Aisha Garza)
Member id
UHC-00750-76
Confidence
1
Method
probabilistic
MBR-026432CLM-408589
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004464
Orphan claim re-pointed
Claims processor
CLM-430305 → UHC-48651-30 (Mariana Gordon)
Member id
UHC-48651-30
Confidence
1
Method
probabilistic
MBR-007032CLM-430305
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004465
Orphan claim re-pointed
Claims processor
CLM-427314 → UHC-10806-16 (Sharon Rodriguez)
Member id
UHC-10806-16
Confidence
0.85
Method
probabilistic
MBR-042107CLM-427314
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004466
Orphan claim re-pointed
Claims processor
CLM-404700 → UHC-03406-45 (Joseph Obrien)
Member id
UHC-03406-45
Confidence
0.99
Method
probabilistic
MBR-023190CLM-404700
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004467
Orphan claim re-pointed
Claims processor
CLM-411659 → UHC-43847-07 (Lisa Sanchez)
Member id
UHC-43847-07
Confidence
0.99
Method
probabilistic
MBR-018703CLM-411659
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004468
Orphan claim re-pointed
Claims processor
CLM-402142 → UHC-32734-85 (Bruce Johnston)
Member id
UHC-32734-85
Confidence
0.97
Method
deterministic
MBR-008126CLM-402142
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004469
Orphan claim re-pointed
Claims processor
CLM-409024 → UHC-02353-12 (Ray Pierce)
Member id
UHC-02353-12
Confidence
1
Method
probabilistic
MBR-010231CLM-409024
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004470
Orphan claim re-pointed
Claims processor
CLM-417206 → UHC-13928-11 (Sarah Reed)
Member id
UHC-13928-11
Confidence
0.97
Method
deterministic
MBR-021703CLM-417206
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004471
Orphan claim re-pointed
Claims processor
CLM-413074 → UHC-81599-10 (Theresa Parker)
Member id
UHC-81599-10
Confidence
0.99
Method
probabilistic
MBR-034749CLM-413074
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004472
Orphan claim re-pointed
Claims processor
CLM-423359 → UHC-80053-21 (Billy Fisher)
Member id
UHC-80053-21
Confidence
1
Method
probabilistic
MBR-013323CLM-423359
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004473
Orphan claim re-pointed
Claims processor
CLM-431527 → UHC-20779-93 (Amanda Kim)
Member id
UHC-20779-93
Confidence
1
Method
probabilistic
MBR-038875CLM-431527
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004474
Orphan claim re-pointed
Claims processor
CLM-409564 → UHC-09486-83 (Carolyn Berry)
Member id
UHC-09486-83
Confidence
1
Method
probabilistic
MBR-025821CLM-409564
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004475
Orphan claim re-pointed
Claims processor
CLM-425673 → UHC-63043-32 (Evelyn Morrison)
Member id
UHC-63043-32
Confidence
1
Method
probabilistic
MBR-001171CLM-425673
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004476
Orphan claim re-pointed
Claims processor
CLM-417467 → UHC-67117-89 (Alice Harper)
Member id
UHC-67117-89
Confidence
0.93
Method
probabilistic
MBR-001612CLM-417467
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004477
Orphan claim re-pointed
Claims processor
CLM-404454 → UHC-92470-78 (Larry Martin)
Member id
UHC-92470-78
Confidence
1
Method
probabilistic
MBR-002466CLM-404454
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004478
Orphan claim re-pointed
Claims processor
CLM-401033 → UHC-90615-72 (Zachary Stune)
Member id
UHC-90615-72
Confidence
0.98
Method
probabilistic
MBR-005689CLM-401033
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004479
Orphan claim re-pointed
Claims processor
CLM-408296 → UHC-34471-48 (Teresa Edwards)
Member id
UHC-34471-48
Confidence
1
Method
probabilistic
MBR-013072CLM-408296
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004480
Orphan claim re-pointed
Claims processor
CLM-412936 → UHC-93843-37 (Carl Lewis)
Member id
UHC-93843-37
Confidence
1
Method
probabilistic
MBR-039725CLM-412936
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004481
Orphan claim re-pointed
Claims processor
CLM-410016 → UHC-48577-49 (Noah Estrada)
Member id
UHC-48577-49
Confidence
0.97
Method
deterministic
MBR-002955CLM-410016
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004482
Orphan claim re-pointed
Claims processor
CLM-417828 → UHC-66935-98 (Ashley Bradley)
Member id
UHC-66935-98
Confidence
1
Method
probabilistic
MBR-000890CLM-417828
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004483
Orphan claim re-pointed
Claims processor
CLM-421609 → UHC-45344-03 (Peter Ford)
Member id
UHC-45344-03
Confidence
0.97
Method
deterministic
MBR-009536CLM-421609
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004484
Orphan claim re-pointed
Claims processor
CLM-417967 → UHC-22549-45 (Jack Dunn)
Member id
UHC-22549-45
Confidence
0.97
Method
probabilistic
MBR-009019CLM-417967
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004485
Orphan claim re-pointed
Claims processor
CLM-407901 → UHC-47589-10 (Bradley Robinson)
Member id
UHC-47589-10
Confidence
0.97
Method
deterministic
MBR-030116CLM-407901
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004486
Orphan claim re-pointed
Claims processor
CLM-415316 → UHC-06212-17 (Sara Scott)
Member id
UHC-06212-17
Confidence
1
Method
probabilistic
MBR-002921CLM-415316
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004487
Orphan claim re-pointed
Claims processor
CLM-427192 → UHC-75188-27 (Carol Murray)
Member id
UHC-75188-27
Confidence
1
Method
probabilistic
MBR-030470CLM-427192
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004488
Orphan claim re-pointed
Claims processor
CLM-409566 → UHC-98542-11 (Jessica Bennett)
Member id
UHC-98542-11
Confidence
1
Method
probabilistic
MBR-012341CLM-409566
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004489
Orphan claim re-pointed
Claims processor
CLM-430232 → UHC-73394-99 (Carol Olson)
Member id
UHC-73394-99
Confidence
0.98
Method
probabilistic
MBR-016766CLM-430232
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 63 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.