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-005740
Orphan claim re-pointed
Claims processor
CLM-420553 → UHC-90507-70 (Joyce Andrews)
Member id
UHC-90507-70
Confidence
1
Method
probabilistic
MBR-027638CLM-420553
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005741
Orphan claim re-pointed
Claims processor
CLM-420672 → UHC-98691-21 (Mary Weber)
Member id
UHC-98691-21
Confidence
1
Method
probabilistic
MBR-030895CLM-420672
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005742
Orphan claim re-pointed
Claims processor
CLM-410423 → UHC-25604-98 (Ethan Grant)
Member id
UHC-25604-98
Confidence
1
Method
probabilistic
MBR-002277CLM-410423
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005743
Orphan claim re-pointed
Claims processor
CLM-428320 → UHC-05597-29 (Cheryl Reynolds)
Member id
UHC-05597-29
Confidence
0.97
Method
deterministic
MBR-006428CLM-428320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005744
Orphan claim re-pointed
Claims processor
CLM-406084 → UHC-37995-02 (Santiago Phillips)
Member id
UHC-37995-02
Confidence
1
Method
probabilistic
MBR-031544CLM-406084
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005745
Orphan claim re-pointed
Claims processor
CLM-408480 → UHC-54175-26 (Lauren Green)
Member id
UHC-54175-26
Confidence
0.97
Method
deterministic
MBR-024828CLM-408480
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005746
Orphan claim re-pointed
Claims processor
CLM-419062 → UHC-29299-52 (Samuel Salazar)
Member id
UHC-29299-52
Confidence
1
Method
probabilistic
MBR-008869CLM-419062
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005747
Orphan claim re-pointed
Claims processor
CLM-423076 → UHC-24883-81 (Roger Powell)
Member id
UHC-24883-81
Confidence
0.94
Method
probabilistic
MBR-020831CLM-423076
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005748
Orphan claim re-pointed
Claims processor
CLM-418956 → UHC-96268-40 (Vincent Le)
Member id
UHC-96268-40
Confidence
1
Method
probabilistic
MBR-015298CLM-418956
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005749
Orphan claim re-pointed
Claims processor
CLM-426794 → UHC-72353-72 (George Ford)
Member id
UHC-72353-72
Confidence
1
Method
probabilistic
MBR-029727CLM-426794
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005750
Orphan claim re-pointed
Claims processor
CLM-426555 → UHC-21646-21 (Julie Hughes)
Member id
UHC-21646-21
Confidence
0.97
Method
deterministic
MBR-009165CLM-426555
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005751
Orphan claim re-pointed
Claims processor
CLM-421160 → UHC-58212-49 (Dorothy Riley)
Member id
UHC-58212-49
Confidence
1
Method
probabilistic
MBR-025909CLM-421160
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005752
Orphan claim re-pointed
Claims processor
CLM-401886 → UHC-96771-85 (Brandon Fox)
Member id
UHC-96771-85
Confidence
0.97
Method
deterministic
MBR-013494CLM-401886
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005753
Orphan claim re-pointed
Claims processor
CLM-421818 → UHC-93326-04 (Larry Morales)
Member id
UHC-93326-04
Confidence
1
Method
probabilistic
MBR-036473CLM-421818
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005754
Orphan claim re-pointed
Claims processor
CLM-401139 → UHC-95454-32 (Logan Sims)
Member id
UHC-95454-32
Confidence
1
Method
probabilistic
MBR-004122CLM-401139
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005755
Orphan claim re-pointed
Claims processor
CLM-402351 → UHC-23993-16 (Frances Porter)
Member id
UHC-23993-16
Confidence
0.97
Method
deterministic
MBR-006514CLM-402351
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005756
Orphan claim re-pointed
Claims processor
CLM-426941 → UHC-09489-58 (Catherine Johnson)
Member id
UHC-09489-58
Confidence
1
Method
probabilistic
MBR-002327CLM-426941
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005757
Orphan claim re-pointed
Claims processor
CLM-428685 → UHC-17057-28 (Cynthia Fuller)
Member id
UHC-17057-28
Confidence
1
Method
probabilistic
MBR-016091CLM-428685
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005758
Orphan claim re-pointed
Claims processor
CLM-419333 → UHC-64701-90 (Gregory James)
Member id
UHC-64701-90
Confidence
1
Method
probabilistic
MBR-009446CLM-419333
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005759
Orphan claim re-pointed
Claims processor
CLM-414034 → UHC-39604-78 (Gerald Taylor)
Member id
UHC-39604-78
Confidence
0.97
Method
deterministic
MBR-011218CLM-414034
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005760
Orphan claim re-pointed
Claims processor
CLM-415294 → UHC-12220-96 (Lucia Schmidt)
Member id
UHC-12220-96
Confidence
0.93
Method
probabilistic
MBR-003057CLM-415294
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005761
Orphan claim re-pointed
Claims processor
CLM-417752 → UHC-91470-77 (Heather Pierce)
Member id
UHC-91470-77
Confidence
0.98
Method
probabilistic
MBR-028120CLM-417752
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005762
Orphan claim re-pointed
Claims processor
CLM-402527 → UHC-86194-82 (Joyce Burton)
Member id
UHC-86194-82
Confidence
0.97
Method
deterministic
MBR-039376CLM-402527
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005763
Orphan claim re-pointed
Claims processor
CLM-404247 → UHC-14129-58 (Juhn Sullivan)
Member id
UHC-14129-58
Confidence
0.97
Method
deterministic
MBR-030628CLM-404247
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005764
Orphan claim re-pointed
Claims processor
CLM-428953 → UHC-99604-61 (Susan Richardson)
Member id
UHC-99604-61
Confidence
1
Method
probabilistic
MBR-022626CLM-428953
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005765
Orphan claim re-pointed
Claims processor
CLM-418186 → UHC-96996-81 (Jennifer Powell)
Member id
UHC-96996-81
Confidence
1
Method
probabilistic
MBR-006519CLM-418186
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005766
Orphan claim re-pointed
Claims processor
CLM-402805 → UHC-42263-40 (Bruce Harper)
Member id
UHC-42263-40
Confidence
1
Method
probabilistic
MBR-013124CLM-402805
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005767
Orphan claim re-pointed
Claims processor
CLM-412601 → UHC-10278-83 (Cheryl Crawford)
Member id
UHC-10278-83
Confidence
0.98
Method
probabilistic
MBR-004854CLM-412601
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005768
Orphan claim re-pointed
Claims processor
CLM-407069 → UHC-40503-63 (Nathan Reid)
Member id
UHC-40503-63
Confidence
1
Method
probabilistic
MBR-004729CLM-407069
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005769
Orphan claim re-pointed
Claims processor
CLM-425052 → UHC-92395-20 (Charles Ortiz)
Member id
UHC-92395-20
Confidence
1
Method
probabilistic
MBR-005373CLM-425052
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005770
Orphan claim re-pointed
Claims processor
CLM-401869 → UHC-63167-30 (Nicholas Andrews)
Member id
UHC-63167-30
Confidence
0.97
Method
deterministic
MBR-019326CLM-401869
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005771
Orphan claim re-pointed
Claims processor
CLM-401489 → UHC-17206-25 (Marcus Watson)
Member id
UHC-17206-25
Confidence
0.97
Method
deterministic
MBR-017330CLM-401489
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005772
Orphan claim re-pointed
Claims processor
CLM-408127 → UHC-30664-27 (Ralph Jacobs)
Member id
UHC-30664-27
Confidence
1
Method
probabilistic
MBR-021843CLM-408127
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005773
Orphan claim re-pointed
Claims processor
CLM-408650 → UHC-72503-97 (Jerry Price)
Member id
UHC-72503-97
Confidence
0.97
Method
deterministic
MBR-041940CLM-408650
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005774
Orphan claim re-pointed
Claims processor
CLM-427408 → UHC-46813-22 (Arun Thompson)
Member id
UHC-46813-22
Confidence
0.97
Method
deterministic
MBR-042853CLM-427408
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005775
Orphan claim re-pointed
Claims processor
CLM-424509 → UHC-98583-63 (Bruce Cruz)
Member id
UHC-98583-63
Confidence
0.87
Method
probabilistic
MBR-004239CLM-424509
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005776
Orphan claim re-pointed
Claims processor
CLM-425801 → UHC-51264-75 (Scott Ward)
Member id
UHC-51264-75
Confidence
0.98
Method
probabilistic
MBR-034553CLM-425801
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005777
Orphan claim re-pointed
Claims processor
CLM-407179 → UHC-59277-27 (Kathlean Silva)
Member id
UHC-59277-27
Confidence
0.97
Method
deterministic
MBR-010706CLM-407179
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005778
Orphan claim re-pointed
Claims processor
CLM-418234 → UHC-38273-80 (Eugene Soto)
Member id
UHC-38273-80
Confidence
0.92
Method
probabilistic
MBR-021235CLM-418234
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005779
Orphan claim re-pointed
Claims processor
CLM-409449 → UHC-97966-71 (Bobby Hernandez)
Member id
UHC-97966-71
Confidence
0.97
Method
deterministic
MBR-021805CLM-409449
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005780
Orphan claim re-pointed
Claims processor
CLM-426324 → UHC-99703-83 (Gloria Guzman)
Member id
UHC-99703-83
Confidence
1
Method
probabilistic
MBR-005756CLM-426324
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005781
Orphan claim re-pointed
Claims processor
CLM-422114 → UHC-73625-05 (Gloria Brooks)
Member id
UHC-73625-05
Confidence
0.99
Method
probabilistic
MBR-017971CLM-422114
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005782
Orphan claim re-pointed
Claims processor
CLM-413249 → UHC-39910-13 (Susan Adams)
Member id
UHC-39910-13
Confidence
1
Method
probabilistic
MBR-014755CLM-413249
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005783
Orphan claim re-pointed
Claims processor
CLM-409117 → UHC-16620-48 (Mary Lee)
Member id
UHC-16620-48
Confidence
1
Method
probabilistic
MBR-033457CLM-409117
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005784
Orphan claim re-pointed
Claims processor
CLM-429784 → UHC-40362-42 (Vincent Ward)
Member id
UHC-40362-42
Confidence
1
Method
probabilistic
MBR-020278CLM-429784
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005785
Orphan claim re-pointed
Claims processor
CLM-405440 → UHC-62926-91 (Jesse Hughes)
Member id
UHC-62926-91
Confidence
0.97
Method
deterministic
MBR-004505CLM-405440
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005786
Orphan claim re-pointed
Claims processor
CLM-413031 → UHC-42291-53 (Brittany Lucas)
Member id
UHC-42291-53
Confidence
1
Method
probabilistic
MBR-006797CLM-413031
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005787
Orphan claim re-pointed
Claims processor
CLM-429015 → UHC-46437-60 (Brenda Green)
Member id
UHC-46437-60
Confidence
1
Method
probabilistic
MBR-011069CLM-429015
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005788
Orphan claim re-pointed
Claims processor
CLM-402595 → UHC-52002-05 (Patricia Graham)
Member id
UHC-52002-05
Confidence
0.97
Method
deterministic
MBR-000440CLM-402595
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005789
Orphan claim re-pointed
Claims processor
CLM-427596 → UHC-06931-94 (Joe Chapman)
Member id
UHC-06931-94
Confidence
1
Method
probabilistic
MBR-029165CLM-427596
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 89 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.