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-004790
Orphan claim re-pointed
Claims processor
CLM-430730 → UHC-27796-57 (Austin Santos)
Member id
UHC-27796-57
Confidence
1
Method
probabilistic
MBR-001096CLM-430730
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004791
Orphan claim re-pointed
Claims processor
CLM-408239 → UHC-78834-80 (Carolyn Sandoval)
Member id
UHC-78834-80
Confidence
1
Method
probabilistic
MBR-024236CLM-408239
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004792
Orphan claim re-pointed
Claims processor
CLM-402269 → UHC-83618-98 (Camila Martinez)
Member id
UHC-83618-98
Confidence
1
Method
probabilistic
MBR-032157CLM-402269
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004793
Orphan claim re-pointed
Claims processor
CLM-402062 → UHC-84370-28 (Barbara Jacobs)
Member id
UHC-84370-28
Confidence
1
Method
probabilistic
MBR-002484CLM-402062
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004794
Orphan claim re-pointed
Claims processor
CLM-429588 → UHC-00755-30 (Joan Mason)
Member id
UHC-00755-30
Confidence
1
Method
probabilistic
MBR-019530CLM-429588
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004795
Orphan claim re-pointed
Claims processor
CLM-429450 → UHC-73700-75 (Christina Garcia)
Member id
UHC-73700-75
Confidence
1.00
Method
probabilistic
MBR-025498CLM-429450
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004796
Orphan claim re-pointed
Claims processor
CLM-412213 → UHC-14032-93 (Dennis Perez)
Member id
UHC-14032-93
Confidence
1
Method
probabilistic
MBR-022525CLM-412213
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004797
Orphan claim re-pointed
Claims processor
CLM-419400 → UHC-74941-59 (Tyler Peters)
Member id
UHC-74941-59
Confidence
1
Method
probabilistic
MBR-002527CLM-419400
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004798
Orphan claim re-pointed
Claims processor
CLM-413939 → UHC-01330-32 (Albert Marshall)
Member id
UHC-01330-32
Confidence
1
Method
probabilistic
MBR-023427CLM-413939
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004799
Orphan claim re-pointed
Claims processor
CLM-418517 → UHC-37938-14 (Virginia Hudson)
Member id
UHC-37938-14
Confidence
1
Method
probabilistic
MBR-017471CLM-418517
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004800
Orphan claim re-pointed
Claims processor
CLM-429781 → UHC-42785-62 (Frances Lawson)
Member id
UHC-42785-62
Confidence
0.94
Method
probabilistic
MBR-007191CLM-429781
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004801
Orphan claim re-pointed
Claims processor
CLM-414188 → UHC-43975-35 (Dennis Castillo)
Member id
UHC-43975-35
Confidence
0.97
Method
deterministic
MBR-003705CLM-414188
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004802
Orphan claim re-pointed
Claims processor
CLM-413718 → UHC-77881-56 (Jacqueline Wagner)
Member id
UHC-77881-56
Confidence
1
Method
probabilistic
MBR-013134CLM-413718
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004803
Orphan claim re-pointed
Claims processor
CLM-407437 → UHC-88794-67 (Christopher Adams)
Member id
UHC-88794-67
Confidence
1
Method
probabilistic
MBR-026656CLM-407437
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004804
Orphan claim re-pointed
Claims processor
CLM-421509 → UHC-40709-05 (Angla Burns)
Member id
UHC-40709-05
Confidence
1
Method
probabilistic
MBR-005336CLM-421509
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004805
Orphan claim re-pointed
Claims processor
CLM-416820 → UHC-87642-81 (Diana Chen)
Member id
UHC-87642-81
Confidence
1
Method
probabilistic
MBR-001286CLM-416820
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004806
Orphan claim re-pointed
Claims processor
CLM-403610 → UHC-77954-08 (Robert Jordan)
Member id
UHC-77954-08
Confidence
0.93
Method
probabilistic
MBR-008675CLM-403610
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004807
Orphan claim re-pointed
Claims processor
CLM-406802 → UHC-22406-82 (Jacob King)
Member id
UHC-22406-82
Confidence
0.99
Method
probabilistic
MBR-001075CLM-406802
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004808
Orphan claim re-pointed
Claims processor
CLM-430490 → UHC-60974-69 (Lucia Welch)
Member id
UHC-60974-69
Confidence
1
Method
probabilistic
MBR-022786CLM-430490
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004809
Orphan claim re-pointed
Claims processor
CLM-431715 → UHC-55885-02 (Carol Lane)
Member id
UHC-55885-02
Confidence
1
Method
probabilistic
MBR-005029CLM-431715
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004810
Orphan claim re-pointed
Claims processor
CLM-427438 → UHC-79164-92 (Julie Garrett)
Member id
UHC-79164-92
Confidence
1
Method
probabilistic
MBR-022053CLM-427438
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004811
Orphan claim re-pointed
Claims processor
CLM-411538 → UHC-33371-57 (Linda Burns)
Member id
UHC-33371-57
Confidence
0.97
Method
deterministic
MBR-031869CLM-411538
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004812
Orphan claim re-pointed
Claims processor
CLM-407451 → UHC-58187-57 (Ann Sullivan)
Member id
UHC-58187-57
Confidence
1
Method
probabilistic
MBR-000819CLM-407451
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004813
Orphan claim re-pointed
Claims processor
CLM-409319 → UHC-44820-99 (Madison Graham)
Member id
UHC-44820-99
Confidence
1
Method
probabilistic
MBR-015270CLM-409319
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004814
Orphan claim re-pointed
Claims processor
CLM-417101 → UHC-28356-24 (Susan McCoy)
Member id
UHC-28356-24
Confidence
0.98
Method
probabilistic
MBR-007550CLM-417101
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004815
Orphan claim re-pointed
Claims processor
CLM-419038 → UHC-32568-63 (Becky Williams)
Member id
UHC-32568-63
Confidence
1
Method
probabilistic
MBR-001471CLM-419038
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004816
Orphan claim re-pointed
Claims processor
CLM-423580 → UHC-99113-47 (Ethan Phillips)
Member id
UHC-99113-47
Confidence
1
Method
probabilistic
MBR-012246CLM-423580
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004817
Orphan claim re-pointed
Claims processor
CLM-414353 → UHC-04909-22 (Rebecca Lewis)
Member id
UHC-04909-22
Confidence
0.97
Method
deterministic
MBR-003560CLM-414353
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004818
Orphan claim re-pointed
Claims processor
CLM-402138 → UHC-32734-85 (Bruce Johnston)
Member id
UHC-32734-85
Confidence
0.97
Method
deterministic
MBR-008126CLM-402138
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004819
Orphan claim re-pointed
Claims processor
CLM-408434 → UHC-85118-52 (Ryan Diaz)
Member id
UHC-85118-52
Confidence
1
Method
probabilistic
MBR-014971CLM-408434
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004820
Orphan claim re-pointed
Claims processor
CLM-408840 → UHC-25927-01 (Carolyn Clark)
Member id
UHC-25927-01
Confidence
1
Method
probabilistic
MBR-007377CLM-408840
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004821
Orphan claim re-pointed
Claims processor
CLM-412895 → UHC-32595-69 (Gregory Delgado)
Member id
UHC-32595-69
Confidence
1
Method
probabilistic
MBR-006263CLM-412895
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004822
Orphan claim re-pointed
Claims processor
CLM-418309 → UHC-48557-53 (Emma Berry)
Member id
UHC-48557-53
Confidence
1
Method
probabilistic
MBR-012455CLM-418309
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004823
Orphan claim re-pointed
Claims processor
CLM-414302 → UHC-10145-26 (Abigail Harrison)
Member id
UHC-10145-26
Confidence
1
Method
probabilistic
MBR-004678CLM-414302
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004824
Orphan claim re-pointed
Claims processor
CLM-402123 → UHC-38610-80 (Philip White)
Member id
UHC-38610-80
Confidence
0.97
Method
deterministic
MBR-017961CLM-402123
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004825
Orphan claim re-pointed
Claims processor
CLM-419752 → UHC-73103-71 (Theresa Garcia)
Member id
UHC-73103-71
Confidence
1
Method
probabilistic
MBR-024303CLM-419752
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004826
Orphan claim re-pointed
Claims processor
CLM-418808 → UHC-25505-58 (Tim Dean)
Member id
UHC-25505-58
Confidence
0.97
Method
deterministic
MBR-017886CLM-418808
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004827
Orphan claim re-pointed
Claims processor
CLM-421628 → UHC-17607-31 (Mei Mills)
Member id
UHC-17607-31
Confidence
0.93
Method
probabilistic
MBR-025475CLM-421628
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004828
Orphan claim re-pointed
Claims processor
CLM-415064 → UHC-10466-66 (Marilyn Jackson)
Member id
UHC-10466-66
Confidence
0.98
Method
probabilistic
MBR-018502CLM-415064
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004829
Orphan claim re-pointed
Claims processor
CLM-412903 → UHC-51193-31 (Barbara Boyd)
Member id
UHC-51193-31
Confidence
1
Method
probabilistic
MBR-010398CLM-412903
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004830
Orphan claim re-pointed
Claims processor
CLM-402945 → UHC-91801-04 (Frances Bailey)
Member id
UHC-91801-04
Confidence
1
Method
probabilistic
MBR-027271CLM-402945
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004831
Orphan claim re-pointed
Claims processor
CLM-401315 → UHC-03305-49 (Abigail Berry)
Member id
UHC-03305-49
Confidence
1
Method
probabilistic
MBR-010063CLM-401315
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004832
Orphan claim re-pointed
Claims processor
CLM-426477 → UHC-38456-67 (Gregory Day)
Member id
UHC-38456-67
Confidence
0.97
Method
deterministic
MBR-025720CLM-426477
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004833
Orphan claim re-pointed
Claims processor
CLM-421560 → UHC-03915-92 (Billy Williams)
Member id
UHC-03915-92
Confidence
1
Method
probabilistic
MBR-002302CLM-421560
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004834
Orphan claim re-pointed
Claims processor
CLM-402660 → UHC-07968-99 (Cheryl Vasquez)
Member id
UHC-07968-99
Confidence
0.97
Method
deterministic
MBR-024152CLM-402660
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004835
Orphan claim re-pointed
Claims processor
CLM-428101 → UHC-84010-93 (Valentina Cole)
Member id
UHC-84010-93
Confidence
1
Method
probabilistic
MBR-003711CLM-428101
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004836
Orphan claim re-pointed
Claims processor
CLM-405006 → UHC-92819-03 (Linda Martinez)
Member id
UHC-92819-03
Confidence
1
Method
probabilistic
MBR-034035CLM-405006
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004837
Orphan claim re-pointed
Claims processor
CLM-427920 → UHC-68920-96 (Walter Duncan)
Member id
UHC-68920-96
Confidence
1
Method
probabilistic
MBR-023178CLM-427920
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004838
Orphan claim re-pointed
Claims processor
CLM-430023 → UHC-44962-59 (Mason Santiago)
Member id
UHC-44962-59
Confidence
1
Method
probabilistic
MBR-013868CLM-430023
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004839
Orphan claim re-pointed
Claims processor
CLM-424715 → UHC-15360-01 (Daniel Jordan)
Member id
UHC-15360-01
Confidence
1
Method
probabilistic
MBR-009084CLM-424715
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 70 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.