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-004690
Orphan claim re-pointed
Claims processor
CLM-403881 → UHC-12264-39 (Timothy Reed)
Member id
UHC-12264-39
Confidence
0.97
Method
deterministic
MBR-015413CLM-403881
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004691
Orphan claim re-pointed
Claims processor
CLM-415893 → UHC-36112-57 (Diego Lane)
Member id
UHC-36112-57
Confidence
1
Method
probabilistic
MBR-005983CLM-415893
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004692
Orphan claim re-pointed
Claims processor
CLM-432810 → UHC-08687-94 (Jennifer Cunningham)
Member id
UHC-08687-94
Confidence
1
Method
probabilistic
MBR-030232CLM-432810
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004693
Orphan claim re-pointed
Claims processor
CLM-408929 → UHC-92591-12 (Kevin Powell)
Member id
UHC-92591-12
Confidence
1
Method
probabilistic
MBR-030990CLM-408929
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004694
Orphan claim re-pointed
Claims processor
CLM-429355 → UHC-35404-84 (Isabella Shaw)
Member id
UHC-35404-84
Confidence
1
Method
probabilistic
MBR-027913CLM-429355
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004695
Orphan claim re-pointed
Claims processor
CLM-409446 → UHC-98481-53 (Joan Moore)
Member id
UHC-98481-53
Confidence
0.97
Method
deterministic
MBR-003082CLM-409446
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004696
Orphan claim re-pointed
Claims processor
CLM-406801 → UHC-22406-82 (Jacob King)
Member id
UHC-22406-82
Confidence
1
Method
probabilistic
MBR-001075CLM-406801
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004697
Orphan claim re-pointed
Claims processor
CLM-419954 → UHC-51257-13 (Joshua Jenkins)
Member id
UHC-51257-13
Confidence
1
Method
probabilistic
MBR-010789CLM-419954
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004698
Orphan claim re-pointed
Claims processor
CLM-408731 → UHC-29359-29 (Kathleen Harris)
Member id
UHC-29359-29
Confidence
0.97
Method
deterministic
MBR-025419CLM-408731
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004699
Orphan claim re-pointed
Claims processor
CLM-402395 → UHC-93922-74 (Randy Harrison)
Member id
UHC-93922-74
Confidence
1
Method
probabilistic
MBR-016777CLM-402395
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004700
Orphan claim re-pointed
Claims processor
CLM-427238 → UHC-80971-11 (Russell King)
Member id
UHC-80971-11
Confidence
0.90
Method
probabilistic
MBR-009481CLM-427238
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004701
Orphan claim re-pointed
Claims processor
CLM-412070 → UHC-05080-57 (Kevin Mejia)
Member id
UHC-05080-57
Confidence
1
Method
probabilistic
MBR-037558CLM-412070
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004702
Orphan claim re-pointed
Claims processor
CLM-404909 → UHC-20206-20 (Kathryn Carpenter)
Member id
UHC-20206-20
Confidence
1
Method
probabilistic
MBR-010993CLM-404909
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004703
Orphan claim re-pointed
Claims processor
CLM-427782 → UHC-24948-24 (Karen Nichols)
Member id
UHC-24948-24
Confidence
0.99
Method
probabilistic
MBR-000555CLM-427782
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004704
Orphan claim re-pointed
Claims processor
CLM-419550 → UHC-62381-32 (Bryan Walker)
Member id
UHC-62381-32
Confidence
1
Method
probabilistic
MBR-018076CLM-419550
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004705
Orphan claim re-pointed
Claims processor
CLM-414162 → UHC-34997-70 (Marc Maldonado)
Member id
UHC-34997-70
Confidence
0.99
Method
probabilistic
MBR-027847CLM-414162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004706
Orphan claim re-pointed
Claims processor
CLM-405886 → UHC-07705-11 (Ethan Robertson)
Member id
UHC-07705-11
Confidence
1
Method
probabilistic
MBR-018236CLM-405886
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004707
Orphan claim re-pointed
Claims processor
CLM-420046 → UHC-49350-55 (Isabella Wallace)
Member id
UHC-49350-55
Confidence
1
Method
probabilistic
MBR-000514CLM-420046
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004708
Orphan claim re-pointed
Claims processor
CLM-431436 → UHC-89581-24 (Dennis Bryant)
Member id
UHC-89581-24
Confidence
1
Method
probabilistic
MBR-034351CLM-431436
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004709
Orphan claim re-pointed
Claims processor
CLM-404966 → UHC-50684-94 (Sam Miller)
Member id
UHC-50684-94
Confidence
1
Method
probabilistic
MBR-006240CLM-404966
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004710
Orphan claim re-pointed
Claims processor
CLM-422891 → UHC-71180-40 (Douglas Matthews)
Member id
UHC-71180-40
Confidence
1
Method
probabilistic
MBR-022863CLM-422891
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004711
Orphan claim re-pointed
Claims processor
CLM-431956 → UHC-42973-31 (Danielle Cruz)
Member id
UHC-42973-31
Confidence
1
Method
probabilistic
MBR-013819CLM-431956
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004712
Orphan claim re-pointed
Claims processor
CLM-400960 → UHC-15651-83 (Patricia Le)
Member id
UHC-15651-83
Confidence
1
Method
probabilistic
MBR-002487CLM-400960
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004713
Orphan claim re-pointed
Claims processor
CLM-411167 → UHC-74741-25 (Jose Morrison)
Member id
UHC-74741-25
Confidence
1
Method
probabilistic
MBR-008883CLM-411167
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004714
Orphan claim re-pointed
Claims processor
CLM-421648 → UHC-54160-30 (Aaron Johnston)
Member id
UHC-54160-30
Confidence
0.97
Method
deterministic
MBR-046386CLM-421648
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004715
Orphan claim re-pointed
Claims processor
CLM-420220 → UHC-19964-20 (Ruth Pierce)
Member id
UHC-19964-20
Confidence
0.99
Method
probabilistic
MBR-000562CLM-420220
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004716
Orphan claim re-pointed
Claims processor
CLM-409864 → UHC-32255-61 (Nicole Woods)
Member id
UHC-32255-61
Confidence
1
Method
probabilistic
MBR-025860CLM-409864
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004717
Orphan claim re-pointed
Claims processor
CLM-430242 → UHC-60706-35 (Adam Cooper)
Member id
UHC-60706-35
Confidence
1
Method
probabilistic
MBR-037035CLM-430242
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004718
Orphan claim re-pointed
Claims processor
CLM-414235 → UHC-45897-76 (Lori Austin)
Member id
UHC-45897-76
Confidence
1
Method
probabilistic
MBR-007093CLM-414235
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004719
Orphan claim re-pointed
Claims processor
CLM-401466 → UHC-10719-99 (Barbara Ruiz)
Member id
UHC-10719-99
Confidence
1
Method
probabilistic
MBR-000222CLM-401466
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004720
Orphan claim re-pointed
Claims processor
CLM-417017 → UHC-45212-97 (Christina Stone)
Member id
UHC-45212-97
Confidence
1
Method
probabilistic
MBR-016931CLM-417017
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004721
Orphan claim re-pointed
Claims processor
CLM-412877 → UHC-84136-34 (Melissa Stevens)
Member id
UHC-84136-34
Confidence
1
Method
probabilistic
MBR-031184CLM-412877
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004722
Orphan claim re-pointed
Claims processor
CLM-416061 → UHC-95205-05 (Donald Matthews)
Member id
UHC-95205-05
Confidence
1
Method
probabilistic
MBR-028854CLM-416061
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004723
Orphan claim re-pointed
Claims processor
CLM-404646 → UHC-53091-93 (Angela Chapman)
Member id
UHC-53091-93
Confidence
0.97
Method
deterministic
MBR-022893CLM-404646
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004724
Orphan claim re-pointed
Claims processor
CLM-428162 → UHC-30097-39 (Shirley Vasquez)
Member id
UHC-30097-39
Confidence
1
Method
probabilistic
MBR-016792CLM-428162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004725
Orphan claim re-pointed
Claims processor
CLM-416656 → UHC-21051-13 (Judith Simpson)
Member id
UHC-21051-13
Confidence
1
Method
probabilistic
MBR-024063CLM-416656
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004726
Orphan claim re-pointed
Claims processor
CLM-410949 → UHC-39292-35 (Lawrence Ortega)
Member id
UHC-39292-35
Confidence
1
Method
probabilistic
MBR-027990CLM-410949
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004727
Orphan claim re-pointed
Claims processor
CLM-406848 → UHC-12071-84 (Abby Mason)
Member id
UHC-12071-84
Confidence
0.97
Method
deterministic
MBR-008654CLM-406848
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004728
Orphan claim re-pointed
Claims processor
CLM-408787 → UHC-51039-01 (Jacob Hoffman)
Member id
UHC-51039-01
Confidence
0.97
Method
deterministic
MBR-011020CLM-408787
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004729
Orphan claim re-pointed
Claims processor
CLM-430316 → UHC-74911-42 (Ethan Weber)
Member id
UHC-74911-42
Confidence
1
Method
probabilistic
MBR-003393CLM-430316
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004730
Orphan claim re-pointed
Claims processor
CLM-424235 → UHC-05960-06 (Kayla Perry)
Member id
UHC-05960-06
Confidence
0.99
Method
probabilistic
MBR-034757CLM-424235
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004731
Orphan claim re-pointed
Claims processor
CLM-415947 → UHC-50761-37 (Jean Wilson)
Member id
UHC-50761-37
Confidence
0.97
Method
deterministic
MBR-035790CLM-415947
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004732
Orphan claim re-pointed
Claims processor
CLM-426745 → UHC-40588-93 (Brenda Butler)
Member id
UHC-40588-93
Confidence
0.97
Method
deterministic
MBR-007584CLM-426745
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004733
Orphan claim re-pointed
Claims processor
CLM-424664 → UHC-60560-81 (Alice Mejia)
Member id
UHC-60560-81
Confidence
1
Method
probabilistic
MBR-030620CLM-424664
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004734
Orphan claim re-pointed
Claims processor
CLM-421452 → UHC-36480-49 (Ralph Jimenez)
Member id
UHC-36480-49
Confidence
1
Method
probabilistic
MBR-008478CLM-421452
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004735
Orphan claim re-pointed
Claims processor
CLM-416265 → UHC-41663-21 (Jonathan Weaver)
Member id
UHC-41663-21
Confidence
1
Method
probabilistic
MBR-004486CLM-416265
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004736
Orphan claim re-pointed
Claims processor
CLM-402887 → UHC-08276-88 (Mark Cole)
Member id
UHC-08276-88
Confidence
1
Method
probabilistic
MBR-007195CLM-402887
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004737
Orphan claim re-pointed
Claims processor
CLM-413957 → UHC-69678-10 (Luis Dunn)
Member id
UHC-69678-10
Confidence
1
Method
probabilistic
MBR-013051CLM-413957
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004738
Orphan claim re-pointed
Claims processor
CLM-425157 → UHC-72647-57 (Sara Hoffman)
Member id
UHC-72647-57
Confidence
0.99
Method
probabilistic
MBR-002943CLM-425157
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004739
Orphan claim re-pointed
Claims processor
CLM-428777 → UHC-57440-22 (Jacob Grant)
Member id
UHC-57440-22
Confidence
1
Method
probabilistic
MBR-013379CLM-428777
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 68 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.