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-005540
Orphan claim re-pointed
Claims processor
CLM-423196 → UHC-36095-33 (Christine Cunningham)
Member id
UHC-36095-33
Confidence
1
Method
probabilistic
MBR-033215CLM-423196
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005541
Orphan claim re-pointed
Claims processor
CLM-427331 → UHC-26863-57 (Camila Phillips)
Member id
UHC-26863-57
Confidence
1
Method
probabilistic
MBR-001942CLM-427331
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005542
Orphan claim re-pointed
Claims processor
CLM-405083 → UHC-84948-25 (Judith Lopez)
Member id
UHC-84948-25
Confidence
1
Method
probabilistic
MBR-003221CLM-405083
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005543
Orphan claim re-pointed
Claims processor
CLM-416851 → UHC-66551-78 (James White)
Member id
UHC-66551-78
Confidence
1
Method
probabilistic
MBR-021791CLM-416851
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005544
Orphan claim re-pointed
Claims processor
CLM-418245 → UHC-42716-67 (Amy McCy)
Member id
UHC-42716-67
Confidence
0.92
Method
probabilistic
MBR-008527CLM-418245
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005545
Orphan claim re-pointed
Claims processor
CLM-431748 → UHC-57676-62 (Mariana Moore)
Member id
UHC-57676-62
Confidence
0.97
Method
deterministic
MBR-027997CLM-431748
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005546
Orphan claim re-pointed
Claims processor
CLM-402129 → UHC-34634-77 (Emily Kennedy)
Member id
UHC-34634-77
Confidence
0.97
Method
deterministic
MBR-005460CLM-402129
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005547
Orphan claim re-pointed
Claims processor
CLM-422830 → UHC-24778-33 (Timothy Carpenter)
Member id
UHC-24778-33
Confidence
0.99
Method
probabilistic
MBR-001065CLM-422830
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005548
Orphan claim re-pointed
Claims processor
CLM-402473 → UHC-31085-72 (Judith Lopez)
Member id
UHC-31085-72
Confidence
0.97
Method
deterministic
MBR-012637CLM-402473
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005549
Orphan claim re-pointed
Claims processor
CLM-431257 → UHC-05043-11 (Andrew Lopez)
Member id
UHC-05043-11
Confidence
1
Method
probabilistic
MBR-042495CLM-431257
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005550
Orphan claim re-pointed
Claims processor
CLM-431361 → UHC-27985-96 (Kimberly Delgado)
Member id
UHC-27985-96
Confidence
0.97
Method
deterministic
MBR-031787CLM-431361
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005551
Orphan claim re-pointed
Claims processor
CLM-407521 → UHC-46334-94 (Keith Nguyen)
Member id
UHC-46334-94
Confidence
1
Method
probabilistic
MBR-001045CLM-407521
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005552
Orphan claim re-pointed
Claims processor
CLM-426779 → UHC-82540-45 (Susan Ward)
Member id
UHC-82540-45
Confidence
1
Method
probabilistic
MBR-000634CLM-426779
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005553
Orphan claim re-pointed
Claims processor
CLM-425721 → UHC-04206-33 (Kathleen Day)
Member id
UHC-04206-33
Confidence
0.99
Method
probabilistic
MBR-005235CLM-425721
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005554
Orphan claim re-pointed
Claims processor
CLM-414212 → UHC-72976-93 (Zachary Aguilar)
Member id
UHC-72976-93
Confidence
0.99
Method
probabilistic
MBR-014440CLM-414212
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005555
Orphan claim re-pointed
Claims processor
CLM-412101 → UHC-91457-63 (Ralph Price)
Member id
UHC-91457-63
Confidence
0.97
Method
probabilistic
MBR-018735CLM-412101
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005556
Orphan claim re-pointed
Claims processor
CLM-422070 → UHC-12199-64 (Fatima Thomas)
Member id
UHC-12199-64
Confidence
1
Method
probabilistic
MBR-022437CLM-422070
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005557
Orphan claim re-pointed
Claims processor
CLM-410418 → UHC-87446-96 (Kelly Miller)
Member id
UHC-87446-96
Confidence
1
Method
probabilistic
MBR-014115CLM-410418
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005558
Orphan claim re-pointed
Claims processor
CLM-403151 → UHC-95688-46 (Diego Jones)
Member id
UHC-95688-46
Confidence
1
Method
probabilistic
MBR-019542CLM-403151
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005559
Orphan claim re-pointed
Claims processor
CLM-427027 → UHC-89619-29 (Doris Armstrong)
Member id
UHC-89619-29
Confidence
1
Method
probabilistic
MBR-034207CLM-427027
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005560
Orphan claim re-pointed
Claims processor
CLM-403553 → UHC-39760-46 (Carolyn Jackson)
Member id
UHC-39760-46
Confidence
1
Method
probabilistic
MBR-012381CLM-403553
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005561
Orphan claim re-pointed
Claims processor
CLM-402177 → UHC-92206-60 (Arthur Reynolds)
Member id
UHC-92206-60
Confidence
1
Method
probabilistic
MBR-013279CLM-402177
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005562
Orphan claim re-pointed
Claims processor
CLM-421682 → UHC-66335-80 (Gabriel Vasquez)
Member id
UHC-66335-80
Confidence
1
Method
probabilistic
MBR-035585CLM-421682
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005563
Orphan claim re-pointed
Claims processor
CLM-419812 → UHC-76634-70 (Margaret Chavez)
Member id
UHC-76634-70
Confidence
1
Method
probabilistic
MBR-016447CLM-419812
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005564
Orphan claim re-pointed
Claims processor
CLM-418554 → UHC-31222-94 (Sara Owens)
Member id
UHC-31222-94
Confidence
1
Method
probabilistic
MBR-002276CLM-418554
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005565
Orphan claim re-pointed
Claims processor
CLM-422913 → UHC-01587-52 (Kayla Mills)
Member id
UHC-01587-52
Confidence
1
Method
probabilistic
MBR-000018CLM-422913
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005566
Orphan claim re-pointed
Claims processor
CLM-432626 → UHC-92029-25 (Edwrd Wright)
Member id
UHC-92029-25
Confidence
1
Method
probabilistic
MBR-002066CLM-432626
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005567
Orphan claim re-pointed
Claims processor
CLM-404095 → UHC-08725-60 (Joshua Mendoza)
Member id
UHC-08725-60
Confidence
1
Method
probabilistic
MBR-011689CLM-404095
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005568
Orphan claim re-pointed
Claims processor
CLM-406513 → UHC-58654-72 (Virginia Berry)
Member id
UHC-58654-72
Confidence
1
Method
probabilistic
MBR-015241CLM-406513
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005569
Orphan claim re-pointed
Claims processor
CLM-423172 → UHC-79845-73 (Kenneth James)
Member id
UHC-79845-73
Confidence
1
Method
probabilistic
MBR-025861CLM-423172
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005570
Orphan claim re-pointed
Claims processor
CLM-427625 → UHC-82292-56 (Lori Allen)
Member id
UHC-82292-56
Confidence
1
Method
probabilistic
MBR-006660CLM-427625
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005571
Orphan claim re-pointed
Claims processor
CLM-425596 → UHC-59041-99 (Aisha Wallace)
Member id
UHC-59041-99
Confidence
1
Method
probabilistic
MBR-021166CLM-425596
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005572
Orphan claim re-pointed
Claims processor
CLM-423984 → UHC-96985-70 (Roger Fox)
Member id
UHC-96985-70
Confidence
0.97
Method
deterministic
MBR-003970CLM-423984
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005573
Orphan claim re-pointed
Claims processor
CLM-408639 → UHC-41485-25 (Ana Stewart)
Member id
UHC-41485-25
Confidence
0.98
Method
probabilistic
MBR-003018CLM-408639
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005574
Orphan claim re-pointed
Claims processor
CLM-432165 → UHC-72535-35 (Rachel Holmes)
Member id
UHC-72535-35
Confidence
1
Method
probabilistic
MBR-015508CLM-432165
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005575
Orphan claim re-pointed
Claims processor
CLM-423665 → UHC-81252-69 (Janice Banks)
Member id
UHC-81252-69
Confidence
0.97
Method
deterministic
MBR-024074CLM-423665
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005576
Orphan claim re-pointed
Claims processor
CLM-431435 → UHC-59072-43 (Susan Welch)
Member id
UHC-59072-43
Confidence
1
Method
probabilistic
MBR-011447CLM-431435
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005577
Orphan claim re-pointed
Claims processor
CLM-427968 → UHC-23075-63 (Benjamin Cunningham)
Member id
UHC-23075-63
Confidence
0.97
Method
deterministic
MBR-029774CLM-427968
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005578
Orphan claim re-pointed
Claims processor
CLM-418652 → UHC-31898-22 (Carol Singh)
Member id
UHC-31898-22
Confidence
1
Method
probabilistic
MBR-015356CLM-418652
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005579
Orphan claim re-pointed
Claims processor
CLM-417745 → UHC-25388-31 (Ruth Crawford)
Member id
UHC-25388-31
Confidence
0.97
Method
deterministic
MBR-011006CLM-417745
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005580
Orphan claim re-pointed
Claims processor
CLM-408062 → UHC-99058-30 (Bruce Ward)
Member id
UHC-99058-30
Confidence
0.98
Method
probabilistic
MBR-007853CLM-408062
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005581
Orphan claim re-pointed
Claims processor
CLM-424262 → UHC-02642-89 (Lawrence Carpenter)
Member id
UHC-02642-89
Confidence
1
Method
probabilistic
MBR-005795CLM-424262
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005582
Orphan claim re-pointed
Claims processor
CLM-415416 → UHC-33879-78 (Bryan Harrison)
Member id
UHC-33879-78
Confidence
0.99
Method
probabilistic
MBR-011825CLM-415416
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005583
Orphan claim re-pointed
Claims processor
CLM-413777 → UHC-93074-15 (Elizabeth Martinez)
Member id
UHC-93074-15
Confidence
1
Method
probabilistic
MBR-014100CLM-413777
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005584
Orphan claim re-pointed
Claims processor
CLM-417608 → UHC-77256-81 (Ashley Montgomery)
Member id
UHC-77256-81
Confidence
1
Method
probabilistic
MBR-027031CLM-417608
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005585
Orphan claim re-pointed
Claims processor
CLM-400601 → UHC-32791-08 (Lisa Fernandez)
Member id
UHC-32791-08
Confidence
1
Method
probabilistic
MBR-035824CLM-400601
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005586
Orphan claim re-pointed
Claims processor
CLM-409238 → UHC-48373-74 (Maria Rice)
Member id
UHC-48373-74
Confidence
1
Method
probabilistic
MBR-011814CLM-409238
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005587
Orphan claim re-pointed
Claims processor
CLM-409519 → UHC-18692-03 (Hiroshi Freeman)
Member id
UHC-18692-03
Confidence
1
Method
probabilistic
MBR-003533CLM-409519
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005588
Orphan claim re-pointed
Claims processor
CLM-400405 → UHC-06862-81 (Aaron Harper)
Member id
UHC-06862-81
Confidence
1
Method
probabilistic
MBR-028504CLM-400405
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005589
Orphan claim re-pointed
Claims processor
CLM-400275 → UHC-92974-96 (Alexander Medina)
Member id
UHC-92974-96
Confidence
1
Method
probabilistic
MBR-015167CLM-400275
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 85 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.