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-005590
Orphan claim re-pointed
Claims processor
CLM-428684 → UHC-74418-07 (Maria Perez)
Member id
UHC-74418-07
Confidence
0.97
Method
deterministic
MBR-009917CLM-428684
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005591
Orphan claim re-pointed
Claims processor
CLM-432086 → UHC-74349-97 (Arthur Wilson)
Member id
UHC-74349-97
Confidence
1
Method
probabilistic
MBR-022966CLM-432086
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005592
Orphan claim re-pointed
Claims processor
CLM-400919 → UHC-61532-06 (Catherine Hoffman)
Member id
UHC-61532-06
Confidence
1
Method
probabilistic
MBR-018829CLM-400919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005593
Orphan claim re-pointed
Claims processor
CLM-410914 → UHC-70981-11 (Diana Chapman)
Member id
UHC-70981-11
Confidence
1
Method
probabilistic
MBR-021218CLM-410914
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005594
Orphan claim re-pointed
Claims processor
CLM-427436 → UHC-79164-92 (Julie Garrett)
Member id
UHC-79164-92
Confidence
1
Method
probabilistic
MBR-022053CLM-427436
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005595
Orphan claim re-pointed
Claims processor
CLM-408309 → UHC-92954-99 (Christine Brown)
Member id
UHC-92954-99
Confidence
1
Method
probabilistic
MBR-001194CLM-408309
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005596
Orphan claim re-pointed
Claims processor
CLM-415213 → UHC-11141-74 (Lucia Holmes)
Member id
UHC-11141-74
Confidence
1
Method
probabilistic
MBR-019290CLM-415213
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005597
Orphan claim re-pointed
Claims processor
CLM-415576 → UHC-18628-86 (Barbara Fisher)
Member id
UHC-18628-86
Confidence
1
Method
probabilistic
MBR-003325CLM-415576
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005598
Orphan claim re-pointed
Claims processor
CLM-400914 → UHC-81585-75 (Gloria Dunn)
Member id
UHC-81585-75
Confidence
1
Method
probabilistic
MBR-032589CLM-400914
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005599
Orphan claim re-pointed
Claims processor
CLM-403884 → UHC-94244-68 (Keith Jordan)
Member id
UHC-94244-68
Confidence
0.97
Method
deterministic
MBR-006415CLM-403884
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005600
Orphan claim re-pointed
Claims processor
CLM-429534 → UHC-79482-59 (Betty Murray)
Member id
UHC-79482-59
Confidence
1
Method
probabilistic
MBR-016198CLM-429534
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005601
Orphan claim re-pointed
Claims processor
CLM-407992 → UHC-31120-14 (Samantha Nunez)
Member id
UHC-31120-14
Confidence
1
Method
probabilistic
MBR-008099CLM-407992
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005602
Orphan claim re-pointed
Claims processor
CLM-431014 → UHC-39944-48 (Omar James)
Member id
UHC-39944-48
Confidence
1
Method
probabilistic
MBR-024434CLM-431014
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005603
Orphan claim re-pointed
Claims processor
CLM-428715 → UHC-71567-41 (Frances Spencer)
Member id
UHC-71567-41
Confidence
0.97
Method
deterministic
MBR-030408CLM-428715
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005604
Orphan claim re-pointed
Claims processor
CLM-422916 → UHC-41100-42 (Justin Hamilton)
Member id
UHC-41100-42
Confidence
1
Method
probabilistic
MBR-023549CLM-422916
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005605
Orphan claim re-pointed
Claims processor
CLM-426911 → UHC-92801-47 (Susan Morrison)
Member id
UHC-92801-47
Confidence
0.97
Method
deterministic
MBR-026560CLM-426911
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005606
Orphan claim re-pointed
Claims processor
CLM-418550 → UHC-73379-98 (Russell Powell)
Member id
UHC-73379-98
Confidence
1
Method
probabilistic
MBR-004017CLM-418550
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005607
Orphan claim re-pointed
Claims processor
CLM-419431 → UHC-87437-98 (Christine Stevens)
Member id
UHC-87437-98
Confidence
1
Method
probabilistic
MBR-020918CLM-419431
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005608
Orphan claim re-pointed
Claims processor
CLM-423240 → UHC-15009-91 (Jackie Diaz)
Member id
UHC-15009-91
Confidence
1
Method
probabilistic
MBR-022650CLM-423240
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005609
Orphan claim re-pointed
Claims processor
CLM-412005 → UHC-57532-94 (Julia Cook)
Member id
UHC-57532-94
Confidence
1
Method
probabilistic
MBR-005790CLM-412005
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005610
Orphan claim re-pointed
Claims processor
CLM-418549 → UHC-73379-98 (Russell Powell)
Member id
UHC-73379-98
Confidence
0.99
Method
probabilistic
MBR-004017CLM-418549
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005611
Orphan claim re-pointed
Claims processor
CLM-426380 → UHC-73892-28 (Anna Boyd)
Member id
UHC-73892-28
Confidence
0.92
Method
probabilistic
MBR-025736CLM-426380
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005612
Orphan claim re-pointed
Claims processor
CLM-418029 → UHC-76486-86 (Katherine Walker)
Member id
UHC-76486-86
Confidence
0.98
Method
probabilistic
MBR-018498CLM-418029
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005613
Orphan claim re-pointed
Claims processor
CLM-422344 → UHC-22273-83 (Martha Dixon)
Member id
UHC-22273-83
Confidence
1
Method
probabilistic
MBR-011803CLM-422344
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005614
Orphan claim re-pointed
Claims processor
CLM-410710 → UHC-96663-83 (Evelyn Williams)
Member id
UHC-96663-83
Confidence
1
Method
probabilistic
MBR-010533CLM-410710
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005615
Orphan claim re-pointed
Claims processor
CLM-402623 → UHC-18828-56 (Luis Vega)
Member id
UHC-18828-56
Confidence
1
Method
probabilistic
MBR-017929CLM-402623
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005616
Orphan claim re-pointed
Claims processor
CLM-430051 → UHC-89611-35 (Gary Chapman)
Member id
UHC-89611-35
Confidence
1
Method
probabilistic
MBR-042539CLM-430051
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005617
Orphan claim re-pointed
Claims processor
CLM-416166 → UHC-35992-83 (Tyler Rose)
Member id
UHC-35992-83
Confidence
1
Method
probabilistic
MBR-010168CLM-416166
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005618
Orphan claim re-pointed
Claims processor
CLM-429284 → UHC-41583-48 (Vincent Ramirez)
Member id
UHC-41583-48
Confidence
1
Method
probabilistic
MBR-007777CLM-429284
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005619
Orphan claim re-pointed
Claims processor
CLM-407074 → UHC-47771-45 (Angela Sanders)
Member id
UHC-47771-45
Confidence
1
Method
probabilistic
MBR-006760CLM-407074
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005620
Orphan claim re-pointed
Claims processor
CLM-416569 → UHC-54398-04 (Julia Hansen)
Member id
UHC-54398-04
Confidence
1
Method
probabilistic
MBR-023998CLM-416569
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005621
Orphan claim re-pointed
Claims processor
CLM-428519 → UHC-35911-04 (Carolyn Log)
Member id
UHC-35911-04
Confidence
0.98
Method
probabilistic
MBR-023875CLM-428519
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005622
Orphan claim re-pointed
Claims processor
CLM-412389 → UHC-11519-51 (Linda Perkins)
Member id
UHC-11519-51
Confidence
1
Method
probabilistic
MBR-033623CLM-412389
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005623
Orphan claim re-pointed
Claims processor
CLM-416482 → UHC-72382-09 (Arthur Guzman)
Member id
UHC-72382-09
Confidence
1
Method
probabilistic
MBR-012434CLM-416482
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005624
Orphan claim re-pointed
Claims processor
CLM-417805 → UHC-54869-17 (Sean Wright)
Member id
UHC-54869-17
Confidence
1
Method
probabilistic
MBR-001876CLM-417805
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005625
Orphan claim re-pointed
Claims processor
CLM-403823 → UHC-84890-95 (Gerald Miller)
Member id
UHC-84890-95
Confidence
0.99
Method
probabilistic
MBR-001149CLM-403823
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005626
Orphan claim re-pointed
Claims processor
CLM-404097 → UHC-08426-20 (Alexander Berry)
Member id
UHC-08426-20
Confidence
1
Method
probabilistic
MBR-023067CLM-404097
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005627
Orphan claim re-pointed
Claims processor
CLM-405703 → UHC-77190-83 (Abigail Little)
Member id
UHC-77190-83
Confidence
1
Method
probabilistic
MBR-019965CLM-405703
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005628
Orphan claim re-pointed
Claims processor
CLM-407478 → UHC-91231-49 (Andrew Contreras)
Member id
UHC-91231-49
Confidence
1
Method
probabilistic
MBR-033039CLM-407478
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005629
Orphan claim re-pointed
Claims processor
CLM-402605 → UHC-15944-44 (Frances Pierce)
Member id
UHC-15944-44
Confidence
1
Method
probabilistic
MBR-010936CLM-402605
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005630
Orphan claim re-pointed
Claims processor
CLM-403239 → UHC-56934-35 (Valentina Duncan)
Member id
UHC-56934-35
Confidence
0.98
Method
probabilistic
MBR-022070CLM-403239
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005631
Orphan claim re-pointed
Claims processor
CLM-424597 → UHC-57735-93 (Jerry Perkins)
Member id
UHC-57735-93
Confidence
1
Method
probabilistic
MBR-029598CLM-424597
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005632
Orphan claim re-pointed
Claims processor
CLM-429666 → UHC-33762-69 (Jack Robertson)
Member id
UHC-33762-69
Confidence
1
Method
probabilistic
MBR-040710CLM-429666
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005633
Orphan claim re-pointed
Claims processor
CLM-407260 → UHC-44419-60 (Lucia Woods)
Member id
UHC-44419-60
Confidence
1
Method
probabilistic
MBR-018410CLM-407260
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005634
Orphan claim re-pointed
Claims processor
CLM-421539 → UHC-53327-52 (Frances Ruiz)
Member id
UHC-53327-52
Confidence
0.94
Method
probabilistic
MBR-005179CLM-421539
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005635
Orphan claim re-pointed
Claims processor
CLM-400070 → UHC-31236-97 (Amber Wells)
Member id
UHC-31236-97
Confidence
0.97
Method
deterministic
MBR-032224CLM-400070
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005636
Orphan claim re-pointed
Claims processor
CLM-410442 → UHC-84531-10 (Amy Yang)
Member id
UHC-84531-10
Confidence
1
Method
probabilistic
MBR-043661CLM-410442
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005637
Orphan claim re-pointed
Claims processor
CLM-408344 → UHC-58073-33 (Alexander Perez)
Member id
UHC-58073-33
Confidence
1
Method
probabilistic
MBR-031568CLM-408344
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005638
Orphan claim re-pointed
Claims processor
CLM-411892 → UHC-60653-85 (Ryan Fuller)
Member id
UHC-60653-85
Confidence
0.97
Method
deterministic
MBR-016758CLM-411892
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005639
Orphan claim re-pointed
Claims processor
CLM-419065 → UHC-32667-67 (Emma Ortiz)
Member id
UHC-32667-67
Confidence
1
Method
probabilistic
MBR-012322CLM-419065
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 86 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.