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-005490
Orphan claim re-pointed
Claims processor
CLM-417501 → UHC-24118-86 (Justin Reyes)
Member id
UHC-24118-86
Confidence
0.97
Method
deterministic
MBR-033902CLM-417501
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005491
Orphan claim re-pointed
Claims processor
CLM-415183 → UHC-81209-58 (Kathryn Price)
Member id
UHC-81209-58
Confidence
0.97
Method
deterministic
MBR-003985CLM-415183
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005492
Orphan claim re-pointed
Claims processor
CLM-420263 → UHC-63051-72 (Martha Nichols)
Member id
UHC-63051-72
Confidence
1
Method
probabilistic
MBR-009016CLM-420263
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005493
Orphan claim re-pointed
Claims processor
CLM-417247 → UHC-89202-61 (Russell Guerrero)
Member id
UHC-89202-61
Confidence
1
Method
probabilistic
MBR-027376CLM-417247
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005494
Orphan claim re-pointed
Claims processor
CLM-419221 → UHC-90077-22 (Wayne Collins)
Member id
UHC-90077-22
Confidence
0.97
Method
deterministic
MBR-015092CLM-419221
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005495
Orphan claim re-pointed
Claims processor
CLM-426788 → UHC-65062-39 (Christian Simmons)
Member id
UHC-65062-39
Confidence
1
Method
probabilistic
MBR-000338CLM-426788
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005496
Orphan claim re-pointed
Claims processor
CLM-415535 → UHC-91234-39 (Kathryn Dunn)
Member id
UHC-91234-39
Confidence
0.97
Method
deterministic
MBR-017717CLM-415535
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005497
Orphan claim re-pointed
Claims processor
CLM-427067 → UHC-57083-46 (Sean Gordon)
Member id
UHC-57083-46
Confidence
0.99
Method
probabilistic
MBR-039055CLM-427067
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005498
Orphan claim re-pointed
Claims processor
CLM-421480 → UHC-84578-81 (Bradley Armstrong)
Member id
UHC-84578-81
Confidence
1
Method
probabilistic
MBR-031694CLM-421480
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005499
Orphan claim re-pointed
Claims processor
CLM-411685 → UHC-00056-21 (Catherine Collins)
Member id
UHC-00056-21
Confidence
1
Method
probabilistic
MBR-002036CLM-411685
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005500
Orphan claim re-pointed
Claims processor
CLM-420171 → UHC-49338-06 (Grace Shaw)
Member id
UHC-49338-06
Confidence
1
Method
probabilistic
MBR-003151CLM-420171
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005501
Orphan claim re-pointed
Claims processor
CLM-414081 → UHC-94329-01 (Rchard Welch)
Member id
UHC-94329-01
Confidence
0.99
Method
probabilistic
MBR-006531CLM-414081
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005502
Orphan claim re-pointed
Claims processor
CLM-409023 → UHC-86468-12 (Maria Hansen)
Member id
UHC-86468-12
Confidence
1
Method
probabilistic
MBR-004770CLM-409023
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005503
Orphan claim re-pointed
Claims processor
CLM-408661 → UHC-82658-64 (Stephen Ross)
Member id
UHC-82658-64
Confidence
0.97
Method
deterministic
MBR-019751CLM-408661
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005504
Orphan claim re-pointed
Claims processor
CLM-402999 → UHC-03857-67 (Bruce Jones)
Member id
UHC-03857-67
Confidence
0.97
Method
deterministic
MBR-008377CLM-402999
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005505
Orphan claim re-pointed
Claims processor
CLM-412570 → UHC-54449-78 (Noah Sims)
Member id
UHC-54449-78
Confidence
1
Method
probabilistic
MBR-018776CLM-412570
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005506
Orphan claim re-pointed
Claims processor
CLM-408130 → UHC-87565-33 (Isabella Stephens)
Member id
UHC-87565-33
Confidence
1
Method
probabilistic
MBR-017835CLM-408130
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005507
Orphan claim re-pointed
Claims processor
CLM-412248 → UHC-95420-85 (Julie Sullivan)
Member id
UHC-95420-85
Confidence
0.99
Method
probabilistic
MBR-019182CLM-412248
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005508
Orphan claim re-pointed
Claims processor
CLM-417028 → UHC-96463-73 (Cheryl Thomas)
Member id
UHC-96463-73
Confidence
0.99
Method
probabilistic
MBR-008313CLM-417028
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005509
Orphan claim re-pointed
Claims processor
CLM-426109 → UHC-89377-66 (Marcus Gilbert)
Member id
UHC-89377-66
Confidence
1
Method
probabilistic
MBR-025589CLM-426109
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005510
Orphan claim re-pointed
Claims processor
CLM-407436 → UHC-93836-27 (Carol Martinez)
Member id
UHC-93836-27
Confidence
0.97
Method
deterministic
MBR-038391CLM-407436
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005511
Orphan claim re-pointed
Claims processor
CLM-412853 → UHC-02361-56 (Judith Vasquez)
Member id
UHC-02361-56
Confidence
1
Method
probabilistic
MBR-001640CLM-412853
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005512
Orphan claim re-pointed
Claims processor
CLM-417907 → UHC-03687-10 (Tricia Bradley)
Member id
UHC-03687-10
Confidence
1
Method
probabilistic
MBR-026369CLM-417907
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005513
Orphan claim re-pointed
Claims processor
CLM-418070 → UHC-80886-56 (Kayla Perez)
Member id
UHC-80886-56
Confidence
0.99
Method
probabilistic
MBR-033737CLM-418070
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005514
Orphan claim re-pointed
Claims processor
CLM-421309 → UHC-39091-36 (Carol Rose)
Member id
UHC-39091-36
Confidence
0.97
Method
deterministic
MBR-025164CLM-421309
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005515
Orphan claim re-pointed
Claims processor
CLM-417187 → UHC-87854-09 (Julia Jackson)
Member id
UHC-87854-09
Confidence
1
Method
probabilistic
MBR-009925CLM-417187
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005516
Orphan claim re-pointed
Claims processor
CLM-406323 → UHC-19581-65 (Sara Carter)
Member id
UHC-19581-65
Confidence
1
Method
probabilistic
MBR-011253CLM-406323
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005517
Orphan claim re-pointed
Claims processor
CLM-432769 → UHC-11191-55 (Margaret Hall)
Member id
UHC-11191-55
Confidence
1
Method
probabilistic
MBR-016511CLM-432769
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005518
Orphan claim re-pointed
Claims processor
CLM-409921 → UHC-51707-54 (Alexis Ruiz)
Member id
UHC-51707-54
Confidence
1
Method
probabilistic
MBR-022587CLM-409921
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005519
Orphan claim re-pointed
Claims processor
CLM-402644 → UHC-52043-76 (Roy Payne)
Member id
UHC-52043-76
Confidence
1
Method
probabilistic
MBR-044318CLM-402644
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005520
Orphan claim re-pointed
Claims processor
CLM-422912 → UHC-80624-66 (Steven McDonald)
Member id
UHC-80624-66
Confidence
1
Method
probabilistic
MBR-016163CLM-422912
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005521
Orphan claim re-pointed
Claims processor
CLM-424129 → UHC-61657-92 (Wei Stevens)
Member id
UHC-61657-92
Confidence
0.97
Method
deterministic
MBR-033162CLM-424129
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005522
Orphan claim re-pointed
Claims processor
CLM-431841 → UHC-72484-78 (Juan Williams)
Member id
UHC-72484-78
Confidence
1
Method
probabilistic
MBR-035022CLM-431841
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005523
Orphan claim re-pointed
Claims processor
CLM-407000 → UHC-64753-11 (Megan Williams)
Member id
UHC-64753-11
Confidence
1
Method
probabilistic
MBR-031715CLM-407000
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005524
Orphan claim re-pointed
Claims processor
CLM-417003 → UHC-69372-05 (Dylan Clark)
Member id
UHC-69372-05
Confidence
0.97
Method
deterministic
MBR-015897CLM-417003
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005525
Orphan claim re-pointed
Claims processor
CLM-405013 → UHC-78188-71 (Arthur Contreras)
Member id
UHC-78188-71
Confidence
1
Method
probabilistic
MBR-016594CLM-405013
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005526
Orphan claim re-pointed
Claims processor
CLM-430560 → UHC-50821-50 (George Estrada)
Member id
UHC-50821-50
Confidence
1
Method
probabilistic
MBR-030503CLM-430560
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005527
Orphan claim re-pointed
Claims processor
CLM-422373 → UHC-54681-25 (Jessica Sanchez)
Member id
UHC-54681-25
Confidence
0.85
Method
probabilistic
MBR-027572CLM-422373
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005528
Orphan claim re-pointed
Claims processor
CLM-430047 → UHC-24100-19 (Martha Powell)
Member id
UHC-24100-19
Confidence
1
Method
probabilistic
MBR-001240CLM-430047
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005529
Orphan claim re-pointed
Claims processor
CLM-408117 → UHC-79098-85 (Elijah Brown)
Member id
UHC-79098-85
Confidence
0.97
Method
deterministic
MBR-002240CLM-408117
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005530
Orphan claim re-pointed
Claims processor
CLM-428560 → UHC-51145-14 (Samuel Medina)
Member id
UHC-51145-14
Confidence
1
Method
probabilistic
MBR-011489CLM-428560
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005531
Orphan claim re-pointed
Claims processor
CLM-431719 → UHC-22895-17 (Maria Armstrong)
Member id
UHC-22895-17
Confidence
1
Method
probabilistic
MBR-007493CLM-431719
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005532
Orphan claim re-pointed
Claims processor
CLM-431625 → UHC-39693-44 (Bruce Harper)
Member id
UHC-39693-44
Confidence
0.98
Method
probabilistic
MBR-020430CLM-431625
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005533
Orphan claim re-pointed
Claims processor
CLM-432153 → UHC-22051-95 (Denise Morales)
Member id
UHC-22051-95
Confidence
0.97
Method
deterministic
MBR-002333CLM-432153
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005534
Orphan claim re-pointed
Claims processor
CLM-419314 → UHC-78221-66 (Kayla McDonald)
Member id
UHC-78221-66
Confidence
1
Method
probabilistic
MBR-028176CLM-419314
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005535
Orphan claim re-pointed
Claims processor
CLM-413417 → UHC-03506-53 (Bobby Miller)
Member id
UHC-03506-53
Confidence
1
Method
probabilistic
MBR-021075CLM-413417
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005536
Orphan claim re-pointed
Claims processor
CLM-429987 → UHC-06749-57 (Raymond Wood)
Member id
UHC-06749-57
Confidence
0.97
Method
deterministic
MBR-009283CLM-429987
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005537
Orphan claim re-pointed
Claims processor
CLM-405081 → UHC-83296-48 (Sofia Fuller)
Member id
UHC-83296-48
Confidence
1
Method
probabilistic
MBR-013156CLM-405081
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005538
Orphan claim re-pointed
Claims processor
CLM-401227 → UHC-92472-25 (Danielle Young)
Member id
UHC-92472-25
Confidence
1
Method
probabilistic
MBR-028148CLM-401227
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005539
Orphan claim re-pointed
Claims processor
CLM-403588 → UHC-69793-41 (Bradley Wallace)
Member id
UHC-69793-41
Confidence
0.97
Method
deterministic
MBR-008185CLM-403588
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 84 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.