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-005290
Orphan claim re-pointed
Claims processor
CLM-432263 → UHC-24573-21 (Bryan Vargas)
Member id
UHC-24573-21
Confidence
1
Method
probabilistic
MBR-004813CLM-432263
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005291
Orphan claim re-pointed
Claims processor
CLM-418974 → UHC-07694-89 (Elizabeth Simmons)
Member id
UHC-07694-89
Confidence
1
Method
probabilistic
MBR-004148CLM-418974
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005292
Orphan claim re-pointed
Claims processor
CLM-412741 → UHC-04603-36 (Harold Patterson)
Member id
UHC-04603-36
Confidence
1
Method
probabilistic
MBR-009556CLM-412741
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005293
Orphan claim re-pointed
Claims processor
CLM-411508 → UHC-73306-19 (Juan Bell)
Member id
UHC-73306-19
Confidence
1
Method
probabilistic
MBR-017652CLM-411508
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005294
Orphan claim re-pointed
Claims processor
CLM-410240 → UHC-81933-20 (Scott Lynch)
Member id
UHC-81933-20
Confidence
1
Method
probabilistic
MBR-032627CLM-410240
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005295
Orphan claim re-pointed
Claims processor
CLM-409192 → UHC-85772-60 (Jerry Rojas)
Member id
UHC-85772-60
Confidence
1
Method
probabilistic
MBR-009572CLM-409192
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005296
Orphan claim re-pointed
Claims processor
CLM-425402 → UHC-43649-73 (Isabella Lee)
Member id
UHC-43649-73
Confidence
1
Method
probabilistic
MBR-005074CLM-425402
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005297
Orphan claim re-pointed
Claims processor
CLM-410009 → UHC-50913-71 (Cynthia Contreras)
Member id
UHC-50913-71
Confidence
1
Method
probabilistic
MBR-030178CLM-410009
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005298
Orphan claim re-pointed
Claims processor
CLM-413526 → UHC-96567-22 (Benjamin Peters)
Member id
UHC-96567-22
Confidence
1
Method
probabilistic
MBR-018103CLM-413526
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005299
Orphan claim re-pointed
Claims processor
CLM-404328 → UHC-34703-52 (Ana Banks)
Member id
UHC-34703-52
Confidence
0.90
Method
probabilistic
MBR-011694CLM-404328
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005300
Orphan claim re-pointed
Claims processor
CLM-411865 → UHC-20637-25 (Helen West)
Member id
UHC-20637-25
Confidence
1
Method
probabilistic
MBR-002772CLM-411865
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005301
Orphan claim re-pointed
Claims processor
CLM-411953 → UHC-77075-98 (Sandra Reyes)
Member id
UHC-77075-98
Confidence
1
Method
probabilistic
MBR-015301CLM-411953
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005302
Orphan claim re-pointed
Claims processor
CLM-423208 → UHC-92535-52 (Willie Munoz)
Member id
UHC-92535-52
Confidence
0.93
Method
probabilistic
MBR-008950CLM-423208
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005303
Orphan claim re-pointed
Claims processor
CLM-425312 → UHC-53770-84 (Ryan Ruiz)
Member id
UHC-53770-84
Confidence
1
Method
probabilistic
MBR-024251CLM-425312
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005304
Orphan claim re-pointed
Claims processor
CLM-410439 → UHC-82278-33 (Martha Chapman)
Member id
UHC-82278-33
Confidence
1
Method
probabilistic
MBR-033918CLM-410439
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005305
Orphan claim re-pointed
Claims processor
CLM-402278 → UHC-75638-23 (Doris Haarper)
Member id
UHC-75638-23
Confidence
0.97
Method
deterministic
MBR-043182CLM-402278
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005306
Orphan claim re-pointed
Claims processor
CLM-405222 → UHC-28414-39 (Lsa Welch)
Member id
UHC-28414-39
Confidence
0.98
Method
probabilistic
MBR-011775CLM-405222
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005307
Orphan claim re-pointed
Claims processor
CLM-418233 → UHC-38273-80 (Eugene Soto)
Member id
UHC-38273-80
Confidence
1
Method
probabilistic
MBR-021235CLM-418233
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005308
Orphan claim re-pointed
Claims processor
CLM-401085 → UHC-79516-15 (Gabriel Brooks)
Member id
UHC-79516-15
Confidence
0.97
Method
deterministic
MBR-008441CLM-401085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005309
Orphan claim re-pointed
Claims processor
CLM-413904 → UHC-33199-01 (Sarah Yang)
Member id
UHC-33199-01
Confidence
1
Method
probabilistic
MBR-012963CLM-413904
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005310
Orphan claim re-pointed
Claims processor
CLM-428187 → UHC-23414-82 (Victoria Ramirez)
Member id
UHC-23414-82
Confidence
1
Method
probabilistic
MBR-008663CLM-428187
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005311
Orphan claim re-pointed
Claims processor
CLM-400114 → UHC-76230-29 (Nancy Patel)
Member id
UHC-76230-29
Confidence
1
Method
probabilistic
MBR-029805CLM-400114
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005312
Orphan claim re-pointed
Claims processor
CLM-425114 → UHC-96746-66 (Christine White)
Member id
UHC-96746-66
Confidence
0.97
Method
deterministic
MBR-001496CLM-425114
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005313
Orphan claim re-pointed
Claims processor
CLM-418964 → UHC-23580-88 (Wei Greene)
Member id
UHC-23580-88
Confidence
0.93
Method
probabilistic
MBR-001761CLM-418964
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005314
Orphan claim re-pointed
Claims processor
CLM-414963 → UHC-56461-21 (Lucia Vega)
Member id
UHC-56461-21
Confidence
1
Method
probabilistic
MBR-011580CLM-414963
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005315
Orphan claim re-pointed
Claims processor
CLM-414448 → UHC-92729-78 (Emily Wells)
Member id
UHC-92729-78
Confidence
0.99
Method
probabilistic
MBR-007218CLM-414448
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005316
Orphan claim re-pointed
Claims processor
CLM-408138 → UHC-72343-79 (Joseph Scott)
Member id
UHC-72343-79
Confidence
1
Method
probabilistic
MBR-021986CLM-408138
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005317
Orphan claim re-pointed
Claims processor
CLM-425368 → UHC-34450-15 (Aaron Edwards)
Member id
UHC-34450-15
Confidence
1
Method
probabilistic
MBR-028556CLM-425368
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005318
Orphan claim re-pointed
Claims processor
CLM-422251 → UHC-31187-24 (Daniel Schmidt)
Member id
UHC-31187-24
Confidence
1
Method
probabilistic
MBR-007628CLM-422251
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005319
Orphan claim re-pointed
Claims processor
CLM-406633 → UHC-85810-37 (Joe Stephens)
Member id
UHC-85810-37
Confidence
0.97
Method
deterministic
MBR-004535CLM-406633
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005320
Orphan claim re-pointed
Claims processor
CLM-427718 → UHC-59486-30 (David Griffin)
Member id
UHC-59486-30
Confidence
0.97
Method
deterministic
MBR-026913CLM-427718
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005321
Orphan claim re-pointed
Claims processor
CLM-409486 → UHC-82032-35 (Margaret Stone)
Member id
UHC-82032-35
Confidence
1
Method
probabilistic
MBR-010299CLM-409486
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005322
Orphan claim re-pointed
Claims processor
CLM-409993 → UHC-77619-57 (Gary Gutierrez)
Member id
UHC-77619-57
Confidence
0.99
Method
probabilistic
MBR-016802CLM-409993
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005323
Orphan claim re-pointed
Claims processor
CLM-427935 → UHC-95217-49 (Amber Guerrero)
Member id
UHC-95217-49
Confidence
1
Method
probabilistic
MBR-011772CLM-427935
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005324
Orphan claim re-pointed
Claims processor
CLM-401612 → UHC-64585-07 (Joan Hunt)
Member id
UHC-64585-07
Confidence
1
Method
probabilistic
MBR-011762CLM-401612
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005325
Orphan claim re-pointed
Claims processor
CLM-429146 → UHC-29743-13 (Nancy Morles)
Member id
UHC-29743-13
Confidence
0.99
Method
probabilistic
MBR-015130CLM-429146
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005326
Orphan claim re-pointed
Claims processor
CLM-416825 → UHC-56670-99 (Cynthia Mason)
Member id
UHC-56670-99
Confidence
1
Method
probabilistic
MBR-005930CLM-416825
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005327
Orphan claim re-pointed
Claims processor
CLM-401736 → UHC-23813-69 (John Gardner)
Member id
UHC-23813-69
Confidence
1
Method
probabilistic
MBR-022166CLM-401736
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005328
Orphan claim re-pointed
Claims processor
CLM-413655 → UHC-48730-84 (Emily Wallace)
Member id
UHC-48730-84
Confidence
1
Method
probabilistic
MBR-013014CLM-413655
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005329
Orphan claim re-pointed
Claims processor
CLM-414008 → UHC-88577-54 (Thomas Watson)
Member id
UHC-88577-54
Confidence
1
Method
probabilistic
MBR-010959CLM-414008
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005330
Orphan claim re-pointed
Claims processor
CLM-427183 → UHC-78868-43 (Jacob Patterson)
Member id
UHC-78868-43
Confidence
0.99
Method
probabilistic
MBR-011261CLM-427183
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005331
Orphan claim re-pointed
Claims processor
CLM-422527 → UHC-51631-22 (Mark Perez)
Member id
UHC-51631-22
Confidence
1
Method
probabilistic
MBR-017921CLM-422527
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005332
Orphan claim re-pointed
Claims processor
CLM-414560 → UHC-22109-31 (Jessica Walsh)
Member id
UHC-22109-31
Confidence
0.97
Method
deterministic
MBR-009644CLM-414560
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005333
Orphan claim re-pointed
Claims processor
CLM-413213 → UHC-96648-95 (Frances Fields)
Member id
UHC-96648-95
Confidence
1
Method
probabilistic
MBR-000357CLM-413213
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005334
Orphan claim re-pointed
Claims processor
CLM-403255 → UHC-85894-33 (Gary Palmer)
Member id
UHC-85894-33
Confidence
0.97
Method
deterministic
MBR-009538CLM-403255
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005335
Orphan claim re-pointed
Claims processor
CLM-408348 → UHC-57936-49 (Stephen Reyes)
Member id
UHC-57936-49
Confidence
1.00
Method
probabilistic
MBR-006649CLM-408348
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005336
Orphan claim re-pointed
Claims processor
CLM-413825 → UHC-64201-19 (Betty Kelly)
Member id
UHC-64201-19
Confidence
0.97
Method
deterministic
MBR-031028CLM-413825
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005337
Orphan claim re-pointed
Claims processor
CLM-430728 → UHC-27796-57 (Austin Santos)
Member id
UHC-27796-57
Confidence
1
Method
probabilistic
MBR-001096CLM-430728
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005338
Orphan claim re-pointed
Claims processor
CLM-431889 → UHC-64261-86 (Carl Campbell)
Member id
UHC-64261-86
Confidence
1
Method
probabilistic
MBR-028313CLM-431889
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005339
Orphan claim re-pointed
Claims processor
CLM-418459 → UHC-94134-10 (Lawrence Russell)
Member id
UHC-94134-10
Confidence
1
Method
probabilistic
MBR-020276CLM-418459
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 80 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.