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-005040
Orphan claim re-pointed
Claims processor
CLM-426873 → UHC-73065-25 (Joseph Berry)
Member id
UHC-73065-25
Confidence
1
Method
probabilistic
MBR-023363CLM-426873
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005041
Orphan claim re-pointed
Claims processor
CLM-401576 → UHC-07883-92 (Noah Le)
Member id
UHC-07883-92
Confidence
0.97
Method
deterministic
MBR-001891CLM-401576
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005042
Orphan claim re-pointed
Claims processor
CLM-402361 → UHC-35872-51 (Cheryl Henry)
Member id
UHC-35872-51
Confidence
1
Method
probabilistic
MBR-026501CLM-402361
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005043
Orphan claim re-pointed
Claims processor
CLM-409996 → UHC-18308-01 (Charlotte Larson)
Member id
UHC-18308-01
Confidence
0.99
Method
probabilistic
MBR-004341CLM-409996
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005044
Orphan claim re-pointed
Claims processor
CLM-425186 → UHC-62292-14 (Ann Holmes)
Member id
UHC-62292-14
Confidence
1
Method
probabilistic
MBR-023245CLM-425186
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005045
Orphan claim re-pointed
Claims processor
CLM-417487 → UHC-12071-81 (Rebecca Hernandez)
Member id
UHC-12071-81
Confidence
0.97
Method
deterministic
MBR-037984CLM-417487
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005046
Orphan claim re-pointed
Claims processor
CLM-420656 → UHC-32056-09 (Cheryl Rose)
Member id
UHC-32056-09
Confidence
1
Method
probabilistic
MBR-028248CLM-420656
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005047
Orphan claim re-pointed
Claims processor
CLM-416356 → UHC-58967-66 (Brittany Sandoval)
Member id
UHC-58967-66
Confidence
1
Method
probabilistic
MBR-034301CLM-416356
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005048
Orphan claim re-pointed
Claims processor
CLM-421508 → UHC-40709-05 (Angla Burns)
Member id
UHC-40709-05
Confidence
1
Method
probabilistic
MBR-005336CLM-421508
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005049
Orphan claim re-pointed
Claims processor
CLM-409818 → UHC-62109-92 (Arthur Spencer)
Member id
UHC-62109-92
Confidence
1
Method
probabilistic
MBR-002878CLM-409818
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005050
Orphan claim re-pointed
Claims processor
CLM-409370 → UHC-09097-49 (Gerald Ramirez)
Member id
UHC-09097-49
Confidence
0.99
Method
probabilistic
MBR-004120CLM-409370
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005051
Orphan claim re-pointed
Claims processor
CLM-429680 → UHC-93915-47 (Barbara Owens)
Member id
UHC-93915-47
Confidence
1
Method
probabilistic
MBR-009932CLM-429680
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005052
Orphan claim re-pointed
Claims processor
CLM-430299 → UHC-82830-37 (Karen Bailey)
Member id
UHC-82830-37
Confidence
1
Method
probabilistic
MBR-000994CLM-430299
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005053
Orphan claim re-pointed
Claims processor
CLM-412580 → UHC-11667-88 (Shirley Sanchez)
Member id
UHC-11667-88
Confidence
1
Method
probabilistic
MBR-012117CLM-412580
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005054
Orphan claim re-pointed
Claims processor
CLM-406661 → UHC-43546-14 (Brandon Allen)
Member id
UHC-43546-14
Confidence
0.97
Method
deterministic
MBR-004478CLM-406661
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005055
Orphan claim re-pointed
Claims processor
CLM-410911 → UHC-73134-47 (Russell Gutierrez)
Member id
UHC-73134-47
Confidence
1
Method
probabilistic
MBR-012852CLM-410911
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005056
Orphan claim re-pointed
Claims processor
CLM-419656 → UHC-70900-77 (Samuel Fields)
Member id
UHC-70900-77
Confidence
1
Method
probabilistic
MBR-013967CLM-419656
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005057
Orphan claim re-pointed
Claims processor
CLM-429644 → UHC-12728-30 (Joshua Campbell)
Member id
UHC-12728-30
Confidence
1
Method
probabilistic
MBR-004368CLM-429644
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005058
Orphan claim re-pointed
Claims processor
CLM-430736 → UHC-59470-91 (Brenda Grant)
Member id
UHC-59470-91
Confidence
1
Method
probabilistic
MBR-012618CLM-430736
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005059
Orphan claim re-pointed
Claims processor
CLM-416330 → UHC-89496-41 (Arthur Wagner)
Member id
UHC-89496-41
Confidence
1
Method
probabilistic
MBR-002559CLM-416330
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005060
Orphan claim re-pointed
Claims processor
CLM-411202 → UHC-46808-96 (Gabriel Castillo)
Member id
UHC-46808-96
Confidence
1
Method
probabilistic
MBR-016589CLM-411202
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005061
Orphan claim re-pointed
Claims processor
CLM-425474 → UHC-33599-32 (Sean Young)
Member id
UHC-33599-32
Confidence
0.97
Method
deterministic
MBR-024788CLM-425474
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005062
Orphan claim re-pointed
Claims processor
CLM-400831 → UHC-00120-23 (Hannah Burke)
Member id
UHC-00120-23
Confidence
1
Method
probabilistic
MBR-015128CLM-400831
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005063
Orphan claim re-pointed
Claims processor
CLM-429967 → UHC-31923-24 (Shirley Fisher)
Member id
UHC-31923-24
Confidence
1
Method
probabilistic
MBR-031224CLM-429967
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005064
Orphan claim re-pointed
Claims processor
CLM-426229 → UHC-72872-02 (Samantha Morris)
Member id
UHC-72872-02
Confidence
0.93
Method
probabilistic
MBR-019686CLM-426229
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005065
Orphan claim re-pointed
Claims processor
CLM-422385 → UHC-97031-33 (Teresa Gonzales)
Member id
UHC-97031-33
Confidence
1
Method
probabilistic
MBR-004871CLM-422385
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005066
Orphan claim re-pointed
Claims processor
CLM-401699 → UHC-66628-01 (Bryan Wang)
Member id
UHC-66628-01
Confidence
1
Method
probabilistic
MBR-009122CLM-401699
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005067
Orphan claim re-pointed
Claims processor
CLM-430915 → UHC-43468-04 (Justin Le)
Member id
UHC-43468-04
Confidence
1
Method
probabilistic
MBR-003225CLM-430915
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005068
Orphan claim re-pointed
Claims processor
CLM-412139 → UHC-45255-44 (Julie Nelson)
Member id
UHC-45255-44
Confidence
1
Method
probabilistic
MBR-034592CLM-412139
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005069
Orphan claim re-pointed
Claims processor
CLM-424574 → UHC-98151-65 (Gary Knight)
Member id
UHC-98151-65
Confidence
0.94
Method
probabilistic
MBR-000224CLM-424574
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005070
Orphan claim re-pointed
Claims processor
CLM-406369 → UHC-10686-47 (Carlos Austin)
Member id
UHC-10686-47
Confidence
1
Method
probabilistic
MBR-029976CLM-406369
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005071
Orphan claim re-pointed
Claims processor
CLM-426796 → UHC-34909-33 (Elijah Montgomery)
Member id
UHC-34909-33
Confidence
1.00
Method
probabilistic
MBR-011870CLM-426796
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005072
Orphan claim re-pointed
Claims processor
CLM-402988 → UHC-52113-23 (Joan Mason)
Member id
UHC-52113-23
Confidence
0.97
Method
deterministic
MBR-008141CLM-402988
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005073
Orphan claim re-pointed
Claims processor
CLM-431172 → UHC-77933-88 (Zachary Adams)
Member id
UHC-77933-88
Confidence
0.99
Method
probabilistic
MBR-005773CLM-431172
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005074
Orphan claim re-pointed
Claims processor
CLM-403098 → UHC-60388-12 (Samantha Jensen)
Member id
UHC-60388-12
Confidence
1
Method
probabilistic
MBR-006766CLM-403098
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005075
Orphan claim re-pointed
Claims processor
CLM-402741 → UHC-37593-70 (Emily Roberts)
Member id
UHC-37593-70
Confidence
1
Method
probabilistic
MBR-011793CLM-402741
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005076
Orphan claim re-pointed
Claims processor
CLM-400255 → UHC-93581-67 (Marcus Garcia)
Member id
UHC-93581-67
Confidence
0.99
Method
probabilistic
MBR-009027CLM-400255
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005077
Orphan claim re-pointed
Claims processor
CLM-423924 → UHC-34181-47 (Marcus Fuller)
Member id
UHC-34181-47
Confidence
1
Method
probabilistic
MBR-004491CLM-423924
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005078
Orphan claim re-pointed
Claims processor
CLM-424140 → UHC-07458-97 (Sofia Walker)
Member id
UHC-07458-97
Confidence
0.97
Method
deterministic
MBR-002935CLM-424140
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005079
Orphan claim re-pointed
Claims processor
CLM-424893 → UHC-79675-76 (Carl Campbell)
Member id
UHC-79675-76
Confidence
1
Method
probabilistic
MBR-015484CLM-424893
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005080
Orphan claim re-pointed
Claims processor
CLM-426327 → UHC-26756-01 (Frank Fernandez)
Member id
UHC-26756-01
Confidence
1
Method
probabilistic
MBR-024771CLM-426327
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005081
Orphan claim re-pointed
Claims processor
CLM-431776 → UHC-44013-32 (Megan Moore)
Member id
UHC-44013-32
Confidence
0.97
Method
deterministic
MBR-029432CLM-431776
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005082
Orphan claim re-pointed
Claims processor
CLM-407980 → UHC-72876-61 (Ralph Gray)
Member id
UHC-72876-61
Confidence
0.97
Method
probabilistic
MBR-009289CLM-407980
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005083
Orphan claim re-pointed
Claims processor
CLM-411277 → UHC-94025-69 (Frank Lawrence)
Member id
UHC-94025-69
Confidence
0.97
Method
deterministic
MBR-011254CLM-411277
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005084
Orphan claim re-pointed
Claims processor
CLM-428302 → UHC-96291-49 (Jonathan Kennedy)
Member id
UHC-96291-49
Confidence
1
Method
probabilistic
MBR-017459CLM-428302
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005085
Orphan claim re-pointed
Claims processor
CLM-413986 → UHC-53015-02 (Kimberly Jones)
Member id
UHC-53015-02
Confidence
0.97
Method
deterministic
MBR-017361CLM-413986
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005086
Orphan claim re-pointed
Claims processor
CLM-417177 → UHC-25263-97 (Brian Elliott)
Member id
UHC-25263-97
Confidence
0.97
Method
deterministic
MBR-004856CLM-417177
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005087
Orphan claim re-pointed
Claims processor
CLM-405297 → UHC-25905-92 (Austin Williams)
Member id
UHC-25905-92
Confidence
0.97
Method
deterministic
MBR-030854CLM-405297
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005088
Orphan claim re-pointed
Claims processor
CLM-428605 → UHC-14029-74 (Kathleen Carr)
Member id
UHC-14029-74
Confidence
1
Method
probabilistic
MBR-006388CLM-428605
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005089
Orphan claim re-pointed
Claims processor
CLM-413517 → UHC-65690-96 (Betsy Perez)
Member id
UHC-65690-96
Confidence
0.97
Method
deterministic
MBR-034384CLM-413517
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 75 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.