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-001740
Orphan claim re-pointed
Claims processor
CLM-430660 → UHC-26690-16 (Judith Schultz)
Member id
UHC-26690-16
Confidence
1
Method
probabilistic
MBR-012876CLM-430660
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001741
Orphan claim re-pointed
Claims processor
CLM-408005 → UHC-99324-88 (Amy Franklin)
Member id
UHC-99324-88
Confidence
0.97
Method
deterministic
MBR-001824CLM-408005
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001742
Orphan claim re-pointed
Claims processor
CLM-402499 → UHC-34796-81 (Brandon Jenkins)
Member id
UHC-34796-81
Confidence
1
Method
probabilistic
MBR-016913CLM-402499
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001743
Orphan claim re-pointed
Claims processor
CLM-409918 → UHC-51890-28 (Gerald Collins)
Member id
UHC-51890-28
Confidence
0.99
Method
probabilistic
MBR-002610CLM-409918
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001744
Orphan claim re-pointed
Claims processor
CLM-406018 → UHC-73426-48 (Kayla Bell)
Member id
UHC-73426-48
Confidence
1
Method
probabilistic
MBR-001435CLM-406018
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001745
Orphan claim re-pointed
Claims processor
CLM-404641 → UHC-56584-90 (Debra Marquez)
Member id
UHC-56584-90
Confidence
1
Method
probabilistic
MBR-001331CLM-404641
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001746
Orphan claim re-pointed
Claims processor
CLM-407283 → UHC-97077-15 (Dylan Rojas)
Member id
UHC-97077-15
Confidence
1
Method
probabilistic
MBR-007714CLM-407283
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001747
Orphan claim re-pointed
Claims processor
CLM-404729 → UHC-29195-03 (Jesse Hernandez)
Member id
UHC-29195-03
Confidence
1
Method
probabilistic
MBR-017638CLM-404729
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001748
Orphan claim re-pointed
Claims processor
CLM-415392 → UHC-75813-69 (Mariana Valdez)
Member id
UHC-75813-69
Confidence
0.99
Method
probabilistic
MBR-009951CLM-415392
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001749
Orphan claim re-pointed
Claims processor
CLM-429098 → UHC-37730-93 (Emily Ramirez)
Member id
UHC-37730-93
Confidence
1
Method
probabilistic
MBR-005932CLM-429098
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001750
Orphan claim re-pointed
Claims processor
CLM-410897 → UHC-14493-37 (Cheryl Kennedy)
Member id
UHC-14493-37
Confidence
1
Method
probabilistic
MBR-022620CLM-410897
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001751
Orphan claim re-pointed
Claims processor
CLM-413707 → UHC-47164-26 (Santiago Moore)
Member id
UHC-47164-26
Confidence
0.98
Method
probabilistic
MBR-007220CLM-413707
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001752
Orphan claim re-pointed
Claims processor
CLM-427249 → UHC-02784-11 (Joshua Rose)
Member id
UHC-02784-11
Confidence
1
Method
probabilistic
MBR-007811CLM-427249
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001753
Orphan claim re-pointed
Claims processor
CLM-412951 → UHC-61964-52 (Jennifer Watson)
Member id
UHC-61964-52
Confidence
0.99
Method
probabilistic
MBR-010890CLM-412951
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001754
Orphan claim re-pointed
Claims processor
CLM-404600 → UHC-47652-65 (Deborah Vazquez)
Member id
UHC-47652-65
Confidence
0.94
Method
probabilistic
MBR-013385CLM-404600
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001755
Orphan claim re-pointed
Claims processor
CLM-401639 → UHC-90696-28 (Charles Marquez)
Member id
UHC-90696-28
Confidence
1
Method
probabilistic
MBR-028422CLM-401639
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001756
Orphan claim re-pointed
Claims processor
CLM-418267 → UHC-79734-63 (Lucia Jensen)
Member id
UHC-79734-63
Confidence
1
Method
probabilistic
MBR-006172CLM-418267
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001757
Orphan claim re-pointed
Claims processor
CLM-430201 → UHC-22797-90 (Philip Olson)
Member id
UHC-22797-90
Confidence
1
Method
probabilistic
MBR-019656CLM-430201
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001758
Orphan claim re-pointed
Claims processor
CLM-424354 → UHC-11129-89 (Henry Ruiz)
Member id
UHC-11129-89
Confidence
0.97
Method
deterministic
MBR-013955CLM-424354
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001759
Orphan claim re-pointed
Claims processor
CLM-415467 → UHC-89857-59 (Zachary Munoz)
Member id
UHC-89857-59
Confidence
1
Method
probabilistic
MBR-025804CLM-415467
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001760
Orphan claim re-pointed
Claims processor
CLM-430365 → UHC-56559-86 (Andrea Ortiz)
Member id
UHC-56559-86
Confidence
1
Method
probabilistic
MBR-023759CLM-430365
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001761
Orphan claim re-pointed
Claims processor
CLM-411702 → UHC-00977-64 (Wei Robinson)
Member id
UHC-00977-64
Confidence
1
Method
probabilistic
MBR-008409CLM-411702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001762
Orphan claim re-pointed
Claims processor
CLM-428926 → UHC-86763-22 (Kimberly Bell)
Member id
UHC-86763-22
Confidence
1
Method
probabilistic
MBR-018763CLM-428926
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001763
Orphan claim re-pointed
Claims processor
CLM-420852 → UHC-17253-37 (Jean Espinoza)
Member id
UHC-17253-37
Confidence
1
Method
probabilistic
MBR-018268CLM-420852
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001764
Orphan claim re-pointed
Claims processor
CLM-431108 → UHC-59244-39 (Jean McCoy)
Member id
UHC-59244-39
Confidence
0.90
Method
probabilistic
MBR-021128CLM-431108
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001765
Orphan claim re-pointed
Claims processor
CLM-400634 → UHC-86309-43 (Brian Cole)
Member id
UHC-86309-43
Confidence
1
Method
probabilistic
MBR-027696CLM-400634
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001766
Orphan claim re-pointed
Claims processor
CLM-420559 → UHC-02890-41 (Nancy Ferguson)
Member id
UHC-02890-41
Confidence
1
Method
probabilistic
MBR-015987CLM-420559
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001767
Orphan claim re-pointed
Claims processor
CLM-432307 → UHC-41143-37 (Kayla Valdez)
Member id
UHC-41143-37
Confidence
1
Method
probabilistic
MBR-004577CLM-432307
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001768
Orphan claim re-pointed
Claims processor
CLM-405655 → UHC-19050-62 (Victoria Evans)
Member id
UHC-19050-62
Confidence
1
Method
probabilistic
MBR-024954CLM-405655
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001769
Orphan claim re-pointed
Claims processor
CLM-430432 → UHC-51846-88 (Joan Medina)
Member id
UHC-51846-88
Confidence
0.97
Method
deterministic
MBR-026812CLM-430432
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001770
Orphan claim re-pointed
Claims processor
CLM-416065 → UHC-48858-85 (Ralph Myers)
Member id
UHC-48858-85
Confidence
0.94
Method
probabilistic
MBR-002827CLM-416065
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001771
Orphan claim re-pointed
Claims processor
CLM-407520 → UHC-06605-29 (Patricia Grant)
Member id
UHC-06605-29
Confidence
1
Method
probabilistic
MBR-034054CLM-407520
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001772
Orphan claim re-pointed
Claims processor
CLM-403435 → UHC-56279-29 (Ryan Patel)
Member id
UHC-56279-29
Confidence
1
Method
probabilistic
MBR-027097CLM-403435
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001773
Orphan claim re-pointed
Claims processor
CLM-425915 → UHC-60558-56 (Ruth Ross)
Member id
UHC-60558-56
Confidence
1
Method
probabilistic
MBR-001545CLM-425915
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001774
Orphan claim re-pointed
Claims processor
CLM-407151 → UHC-38319-19 (Hannah Rose)
Member id
UHC-38319-19
Confidence
1
Method
probabilistic
MBR-006459CLM-407151
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001775
Orphan claim re-pointed
Claims processor
CLM-416509 → UHC-83152-41 (Roy Watson)
Member id
UHC-83152-41
Confidence
1
Method
probabilistic
MBR-013024CLM-416509
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001776
Orphan claim re-pointed
Claims processor
CLM-425315 → UHC-76683-43 (Ralph Henderson)
Member id
UHC-76683-43
Confidence
1
Method
probabilistic
MBR-038548CLM-425315
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001777
Orphan claim re-pointed
Claims processor
CLM-401865 → UHC-30122-51 (Gary Walker)
Member id
UHC-30122-51
Confidence
1
Method
probabilistic
MBR-008924CLM-401865
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001778
Orphan claim re-pointed
Claims processor
CLM-419111 → UHC-14047-09 (Jackie Nelson)
Member id
UHC-14047-09
Confidence
1
Method
probabilistic
MBR-008961CLM-419111
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001779
Orphan claim re-pointed
Claims processor
CLM-423073 → UHC-62601-51 (Shirley Obrien)
Member id
UHC-62601-51
Confidence
1
Method
probabilistic
MBR-003413CLM-423073
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001780
Orphan claim re-pointed
Claims processor
CLM-419398 → UHC-98369-55 (Doris Fernandez)
Member id
UHC-98369-55
Confidence
1
Method
probabilistic
MBR-011047CLM-419398
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001781
Orphan claim re-pointed
Claims processor
CLM-410142 → UHC-63728-04 (William Contreras)
Member id
UHC-63728-04
Confidence
1
Method
probabilistic
MBR-012337CLM-410142
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001782
Orphan claim re-pointed
Claims processor
CLM-416034 → UHC-76735-60 (Mateo Chen)
Member id
UHC-76735-60
Confidence
0.97
Method
deterministic
MBR-006431CLM-416034
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001783
Orphan claim re-pointed
Claims processor
CLM-425345 → UHC-20067-85 (Lawrence Gutierrez)
Member id
UHC-20067-85
Confidence
0.97
Method
deterministic
MBR-017425CLM-425345
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001784
Orphan claim re-pointed
Claims processor
CLM-409016 → UHC-59953-53 (Michelle Kennedy)
Member id
UHC-59953-53
Confidence
0.97
Method
deterministic
MBR-014323CLM-409016
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001785
Orphan claim re-pointed
Claims processor
CLM-417137 → UHC-61321-56 (Christine Davis)
Member id
UHC-61321-56
Confidence
1
Method
probabilistic
MBR-008504CLM-417137
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001786
Orphan claim re-pointed
Claims processor
CLM-400555 → UHC-38544-97 (Frances Wilson)
Member id
UHC-38544-97
Confidence
1
Method
probabilistic
MBR-035057CLM-400555
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001787
Orphan claim re-pointed
Claims processor
CLM-404850 → UHC-74882-51 (Heather McDonald)
Member id
UHC-74882-51
Confidence
0.97
Method
deterministic
MBR-013495CLM-404850
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001788
Orphan claim re-pointed
Claims processor
CLM-400680 → UHC-06356-88 (Evelyn Brooks)
Member id
UHC-06356-88
Confidence
1
Method
probabilistic
MBR-022201CLM-400680
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001789
Orphan claim re-pointed
Claims processor
CLM-431545 → UHC-60838-89 (Christian Henry)
Member id
UHC-60838-89
Confidence
0.99
Method
probabilistic
MBR-008611CLM-431545
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 9 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.