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-004840
Orphan claim re-pointed
Claims processor
CLM-410286 → UHC-57632-09 (Daniel Alvarez)
Member id
UHC-57632-09
Confidence
1
Method
probabilistic
MBR-011255CLM-410286
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004841
Orphan claim re-pointed
Claims processor
CLM-420698 → UHC-66472-11 (Carolyn Wheeler)
Member id
UHC-66472-11
Confidence
1
Method
probabilistic
MBR-042845CLM-420698
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004842
Orphan claim re-pointed
Claims processor
CLM-418506 → UHC-20425-50 (Emma Parker)
Member id
UHC-20425-50
Confidence
0.97
Method
deterministic
MBR-002895CLM-418506
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004843
Orphan claim re-pointed
Claims processor
CLM-423931 → UHC-40678-20 (Lori Yang)
Member id
UHC-40678-20
Confidence
1
Method
probabilistic
MBR-004639CLM-423931
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004844
Orphan claim re-pointed
Claims processor
CLM-400580 → UHC-82947-39 (William Contreras)
Member id
UHC-82947-39
Confidence
0.87
Method
probabilistic
MBR-023815CLM-400580
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004845
Orphan claim re-pointed
Claims processor
CLM-424714 → UHC-15360-01 (Daniel Jordan)
Member id
UHC-15360-01
Confidence
1
Method
probabilistic
MBR-009084CLM-424714
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004846
Orphan claim re-pointed
Claims processor
CLM-402333 → UHC-92871-62 (Hannah Brooks)
Member id
UHC-92871-62
Confidence
0.97
Method
deterministic
MBR-024907CLM-402333
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004847
Orphan claim re-pointed
Claims processor
CLM-420507 → UHC-34589-55 (Judith Sanchez)
Member id
UHC-34589-55
Confidence
1
Method
probabilistic
MBR-028901CLM-420507
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004848
Orphan claim re-pointed
Claims processor
CLM-421592 → UHC-60624-22 (Bobby Castro)
Member id
UHC-60624-22
Confidence
0.99
Method
probabilistic
MBR-009179CLM-421592
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004849
Orphan claim re-pointed
Claims processor
CLM-430376 → UHC-04065-77 (Smantha Ruiz)
Member id
UHC-04065-77
Confidence
0.97
Method
deterministic
MBR-018068CLM-430376
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004850
Orphan claim re-pointed
Claims processor
CLM-415149 → UHC-56477-42 (Marcus Carr)
Member id
UHC-56477-42
Confidence
0.93
Method
probabilistic
MBR-010875CLM-415149
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004851
Orphan claim re-pointed
Claims processor
CLM-415309 → UHC-19255-33 (Brandon Rivera)
Member id
UHC-19255-33
Confidence
1
Method
probabilistic
MBR-004545CLM-415309
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004852
Orphan claim re-pointed
Claims processor
CLM-422177 → UHC-47758-36 (Austin Tucker)
Member id
UHC-47758-36
Confidence
1
Method
probabilistic
MBR-009758CLM-422177
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004853
Orphan claim re-pointed
Claims processor
CLM-422767 → UHC-91026-53 (Joe Obrien)
Member id
UHC-91026-53
Confidence
1
Method
probabilistic
MBR-006410CLM-422767
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004854
Orphan claim re-pointed
Claims processor
CLM-410330 → UHC-74277-24 (Ronald Watkins)
Member id
UHC-74277-24
Confidence
1
Method
probabilistic
MBR-011873CLM-410330
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004855
Orphan claim re-pointed
Claims processor
CLM-417952 → UHC-06317-61 (Ann Long)
Member id
UHC-06317-61
Confidence
1
Method
probabilistic
MBR-043581CLM-417952
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004856
Orphan claim re-pointed
Claims processor
CLM-422071 → UHC-73850-59 (Gerald Parker)
Member id
UHC-73850-59
Confidence
1
Method
probabilistic
MBR-002017CLM-422071
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004857
Orphan claim re-pointed
Claims processor
CLM-418316 → UHC-17288-64 (Joan Anderson)
Member id
UHC-17288-64
Confidence
1
Method
probabilistic
MBR-023128CLM-418316
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004858
Orphan claim re-pointed
Claims processor
CLM-431819 → UHC-54842-57 (Linda Munoz)
Member id
UHC-54842-57
Confidence
1
Method
probabilistic
MBR-016290CLM-431819
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004859
Orphan claim re-pointed
Claims processor
CLM-423443 → UHC-77518-93 (Stephen Payne)
Member id
UHC-77518-93
Confidence
0.93
Method
probabilistic
MBR-032993CLM-423443
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004860
Orphan claim re-pointed
Claims processor
CLM-419824 → UHC-24963-18 (Santiago Obrien)
Member id
UHC-24963-18
Confidence
0.98
Method
probabilistic
MBR-003041CLM-419824
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004861
Orphan claim re-pointed
Claims processor
CLM-412577 → UHC-43516-61 (Joe Ford)
Member id
UHC-43516-61
Confidence
1
Method
probabilistic
MBR-013387CLM-412577
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004862
Orphan claim re-pointed
Claims processor
CLM-409851 → UHC-99350-16 (Denise Stephens)
Member id
UHC-99350-16
Confidence
1
Method
probabilistic
MBR-029228CLM-409851
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004863
Orphan claim re-pointed
Claims processor
CLM-407279 → UHC-25477-01 (Nathan Singh)
Member id
UHC-25477-01
Confidence
0.97
Method
deterministic
MBR-036227CLM-407279
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004864
Orphan claim re-pointed
Claims processor
CLM-409390 → UHC-56406-57 (Jonathan Gardner)
Member id
UHC-56406-57
Confidence
1
Method
probabilistic
MBR-004328CLM-409390
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004865
Orphan claim re-pointed
Claims processor
CLM-416095 → UHC-12370-45 (Sandra Mason)
Member id
UHC-12370-45
Confidence
1
Method
probabilistic
MBR-000494CLM-416095
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004866
Orphan claim re-pointed
Claims processor
CLM-431166 → UHC-25672-92 (Elizabeth Myers)
Member id
UHC-25672-92
Confidence
0.97
Method
deterministic
MBR-009176CLM-431166
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004867
Orphan claim re-pointed
Claims processor
CLM-402607 → UHC-70632-75 (Gerald Howell)
Member id
UHC-70632-75
Confidence
0.93
Method
probabilistic
MBR-038663CLM-402607
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004868
Orphan claim re-pointed
Claims processor
CLM-413749 → UHC-93422-08 (Gregory Mendez)
Member id
UHC-93422-08
Confidence
1
Method
probabilistic
MBR-030510CLM-413749
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004869
Orphan claim re-pointed
Claims processor
CLM-412648 → UHC-69097-81 (Janet Young)
Member id
UHC-69097-81
Confidence
1
Method
probabilistic
MBR-006630CLM-412648
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004870
Orphan claim re-pointed
Claims processor
CLM-426660 → UHC-67515-75 (Debra Lee)
Member id
UHC-67515-75
Confidence
1
Method
probabilistic
MBR-022321CLM-426660
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004871
Orphan claim re-pointed
Claims processor
CLM-414087 → UHC-63894-92 (Tyler Adams)
Member id
UHC-63894-92
Confidence
1
Method
probabilistic
MBR-009269CLM-414087
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004872
Orphan claim re-pointed
Claims processor
CLM-422632 → UHC-13473-34 (Heather Hudson)
Member id
UHC-13473-34
Confidence
1
Method
probabilistic
MBR-022411CLM-422632
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004873
Orphan claim re-pointed
Claims processor
CLM-409902 → UHC-70834-58 (Kevin Coleman)
Member id
UHC-70834-58
Confidence
1
Method
probabilistic
MBR-035647CLM-409902
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004874
Orphan claim re-pointed
Claims processor
CLM-417338 → UHC-14545-99 (Jerry Ramos)
Member id
UHC-14545-99
Confidence
0.99
Method
probabilistic
MBR-011707CLM-417338
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004875
Orphan claim re-pointed
Claims processor
CLM-405690 → UHC-73022-03 (Ruth Hanson)
Member id
UHC-73022-03
Confidence
1
Method
probabilistic
MBR-017141CLM-405690
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004876
Orphan claim re-pointed
Claims processor
CLM-420948 → UHC-52531-44 (Jason Murray)
Member id
UHC-52531-44
Confidence
1
Method
probabilistic
MBR-031042CLM-420948
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004877
Orphan claim re-pointed
Claims processor
CLM-403224 → UHC-94863-84 (Michael Campbell)
Member id
UHC-94863-84
Confidence
1
Method
probabilistic
MBR-013984CLM-403224
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004878
Orphan claim re-pointed
Claims processor
CLM-415128 → UHC-47059-01 (Natalie Henry)
Member id
UHC-47059-01
Confidence
1
Method
probabilistic
MBR-022809CLM-415128
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004879
Orphan claim re-pointed
Claims processor
CLM-412651 → UHC-37643-23 (Evelyn Stewart)
Member id
UHC-37643-23
Confidence
1
Method
probabilistic
MBR-008257CLM-412651
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004880
Orphan claim re-pointed
Claims processor
CLM-409668 → UHC-50547-71 (Barb Hansen)
Member id
UHC-50547-71
Confidence
1
Method
probabilistic
MBR-005050CLM-409668
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004881
Orphan claim re-pointed
Claims processor
CLM-422428 → UHC-60111-01 (Doris Frod)
Member id
UHC-60111-01
Confidence
0.98
Method
probabilistic
MBR-023725CLM-422428
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004882
Orphan claim re-pointed
Claims processor
CLM-431397 → UHC-69637-54 (Jesse Stewart)
Member id
UHC-69637-54
Confidence
0.89
Method
probabilistic
MBR-011341CLM-431397
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004883
Orphan claim re-pointed
Claims processor
CLM-420132 → UHC-58560-58 (Lawrence Butler)
Member id
UHC-58560-58
Confidence
1
Method
probabilistic
MBR-006792CLM-420132
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004884
Orphan claim re-pointed
Claims processor
CLM-423846 → UHC-35977-69 (Anna Wong)
Member id
UHC-35977-69
Confidence
0.94
Method
probabilistic
MBR-026522CLM-423846
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004885
Orphan claim re-pointed
Claims processor
CLM-410649 → UHC-75411-44 (Hiroshi Lynch)
Member id
UHC-75411-44
Confidence
1
Method
probabilistic
MBR-030605CLM-410649
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004886
Orphan claim re-pointed
Claims processor
CLM-430618 → UHC-38405-46 (Peter Burton)
Member id
UHC-38405-46
Confidence
0.99
Method
probabilistic
MBR-031375CLM-430618
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004887
Orphan claim re-pointed
Claims processor
CLM-421841 → UHC-79864-92 (Philip Owens)
Member id
UHC-79864-92
Confidence
1
Method
probabilistic
MBR-017216CLM-421841
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004888
Orphan claim re-pointed
Claims processor
CLM-412320 → UHC-51105-44 (Diana Porter)
Member id
UHC-51105-44
Confidence
0.97
Method
deterministic
MBR-043405CLM-412320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004889
Orphan claim re-pointed
Claims processor
CLM-428208 → UHC-11771-53 (Abby Murray)
Member id
UHC-11771-53
Confidence
1
Method
probabilistic
MBR-021972CLM-428208
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 71 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.