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
Orphan claim re-pointed, Claims processor, 0 proposed
ActionTypeTitleDetailLinked toStatusExecuted
ACT-001340
Orphan claim re-pointed
Claims processor
CLM-403288 → UHC-81817-78 (Shirley Harvey)
Member id
UHC-81817-78
Confidence
0.97
Method
deterministic
MBR-035251CLM-403288
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001341
Orphan claim re-pointed
Claims processor
CLM-409453 → UHC-06553-73 (Pamela Yang)
Member id
UHC-06553-73
Confidence
0.97
Method
deterministic
MBR-006193CLM-409453
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001342
Orphan claim re-pointed
Claims processor
CLM-415528 → UHC-11930-34 (Amy Wright)
Member id
UHC-11930-34
Confidence
1
Method
probabilistic
MBR-029856CLM-415528
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001343
Orphan claim re-pointed
Claims processor
CLM-414432 → UHC-15556-78 (Justin Snyder)
Member id
UHC-15556-78
Confidence
1
Method
probabilistic
MBR-004064CLM-414432
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001344
Orphan claim re-pointed
Claims processor
CLM-429901 → UHC-05517-87 (Mark Nelson)
Member id
UHC-05517-87
Confidence
0.93
Method
probabilistic
MBR-009860CLM-429901
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001345
Orphan claim re-pointed
Claims processor
CLM-428305 → UHC-63351-43 (Jerry Perkins)
Member id
UHC-63351-43
Confidence
1
Method
probabilistic
MBR-007345CLM-428305
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001346
Orphan claim re-pointed
Claims processor
CLM-400406 → UHC-06862-81 (Aaron Harper)
Member id
UHC-06862-81
Confidence
1
Method
probabilistic
MBR-028504CLM-400406
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001347
Orphan claim re-pointed
Claims processor
CLM-421183 → UHC-18725-71 (Gary Guerrero)
Member id
UHC-18725-71
Confidence
0.97
Method
deterministic
MBR-024485CLM-421183
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001348
Orphan claim re-pointed
Claims processor
CLM-427685 → UHC-22892-68 (Jesse Peterson)
Member id
UHC-22892-68
Confidence
1
Method
probabilistic
MBR-003718CLM-427685
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001349
Orphan claim re-pointed
Claims processor
CLM-420295 → UHC-17734-66 (Susan Jackson)
Member id
UHC-17734-66
Confidence
0.99
Method
probabilistic
MBR-026778CLM-420295
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001350
Orphan claim re-pointed
Claims processor
CLM-416029 → UHC-03400-57 (Lori Gibson)
Member id
UHC-03400-57
Confidence
0.98
Method
probabilistic
MBR-018071CLM-416029
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001351
Orphan claim re-pointed
Claims processor
CLM-423678 → UHC-38974-87 (Adam Griffin)
Member id
UHC-38974-87
Confidence
0.99
Method
probabilistic
MBR-008268CLM-423678
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001352
Orphan claim re-pointed
Claims processor
CLM-407989 → UHC-37140-99 (Camila Sims)
Member id
UHC-37140-99
Confidence
1
Method
probabilistic
MBR-013486CLM-407989
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001353
Orphan claim re-pointed
Claims processor
CLM-402703 → UHC-55663-84 (Donna Russell)
Member id
UHC-55663-84
Confidence
1
Method
probabilistic
MBR-037666CLM-402703
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001354
Orphan claim re-pointed
Claims processor
CLM-407140 → UHC-71190-27 (Alice Spencer)
Member id
UHC-71190-27
Confidence
1
Method
probabilistic
MBR-040693CLM-407140
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001355
Orphan claim re-pointed
Claims processor
CLM-419476 → UHC-37209-76 (Olivia Dunn)
Member id
UHC-37209-76
Confidence
0.97
Method
deterministic
MBR-029780CLM-419476
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001356
Orphan claim re-pointed
Claims processor
CLM-411580 → UHC-39070-93 (Samuel Williamson)
Member id
UHC-39070-93
Confidence
1
Method
probabilistic
MBR-010091CLM-411580
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001357
Orphan claim re-pointed
Claims processor
CLM-401561 → UHC-59698-55 (Jessica Elllis)
Member id
UHC-59698-55
Confidence
0.99
Method
probabilistic
MBR-036920CLM-401561
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001358
Orphan claim re-pointed
Claims processor
CLM-418488 → UHC-29960-66 (Julia Perkins)
Member id
UHC-29960-66
Confidence
1
Method
probabilistic
MBR-029198CLM-418488
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001359
Orphan claim re-pointed
Claims processor
CLM-423756 → UHC-90029-18 (Bradley Hughes)
Member id
UHC-90029-18
Confidence
1
Method
probabilistic
MBR-032283CLM-423756
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001360
Orphan claim re-pointed
Claims processor
CLM-404732 → UHC-96679-77 (Ann Cook)
Member id
UHC-96679-77
Confidence
1
Method
probabilistic
MBR-012441CLM-404732
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001361
Orphan claim re-pointed
Claims processor
CLM-424375 → UHC-86900-82 (Bowman Bowman)
Member id
UHC-86900-82
Confidence
0.93
Method
probabilistic
MBR-005470CLM-424375
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001362
Orphan claim re-pointed
Claims processor
CLM-412946 → UHC-66079-97 (Kyle Phillips)
Member id
UHC-66079-97
Confidence
0.97
Method
deterministic
MBR-000157CLM-412946
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001363
Orphan claim re-pointed
Claims processor
CLM-419172 → UHC-76600-57 (Frank Ramos)
Member id
UHC-76600-57
Confidence
1
Method
probabilistic
MBR-003182CLM-419172
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001364
Orphan claim re-pointed
Claims processor
CLM-403733 → UHC-96431-19 (Kathryn Wang)
Member id
UHC-96431-19
Confidence
1
Method
probabilistic
MBR-001987CLM-403733
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001365
Orphan claim re-pointed
Claims processor
CLM-404402 → UHC-87281-93 (Lisa Campbell)
Member id
UHC-87281-93
Confidence
0.99
Method
probabilistic
MBR-030188CLM-404402
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001366
Orphan claim re-pointed
Claims processor
CLM-407293 → UHC-64583-03 (Kimberly White)
Member id
UHC-64583-03
Confidence
1
Method
probabilistic
MBR-021603CLM-407293
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001367
Orphan claim re-pointed
Claims processor
CLM-411602 → UHC-53647-10 (Amanda Hansen)
Member id
UHC-53647-10
Confidence
1
Method
probabilistic
MBR-019699CLM-411602
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001368
Orphan claim re-pointed
Claims processor
CLM-428002 → UHC-38530-83 (Helen Garcia)
Member id
UHC-38530-83
Confidence
0.99
Method
probabilistic
MBR-012289CLM-428002
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001369
Orphan claim re-pointed
Claims processor
CLM-405400 → UHC-42573-34 (Marilyn Nguyen)
Member id
UHC-42573-34
Confidence
1
Method
probabilistic
MBR-031549CLM-405400
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001370
Orphan claim re-pointed
Claims processor
CLM-408369 → UHC-54625-23 (Mason Maldonado)
Member id
UHC-54625-23
Confidence
1
Method
probabilistic
MBR-004536CLM-408369
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001371
Orphan claim re-pointed
Claims processor
CLM-400741 → UHC-19865-62 (Adam Simpson)
Member id
UHC-19865-62
Confidence
1
Method
probabilistic
MBR-030497CLM-400741
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001372
Orphan claim re-pointed
Claims processor
CLM-410015 → UHC-48577-49 (Noah Estrada)
Member id
UHC-48577-49
Confidence
0.97
Method
deterministic
MBR-002955CLM-410015
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001373
Orphan claim re-pointed
Claims processor
CLM-428649 → UHC-61970-31 (Mason Arnold)
Member id
UHC-61970-31
Confidence
0.97
Method
deterministic
MBR-043817CLM-428649
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001374
Orphan claim re-pointed
Claims processor
CLM-416854 → UHC-92808-15 (Jeffrey Mendoza)
Member id
UHC-92808-15
Confidence
1
Method
probabilistic
MBR-014882CLM-416854
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001375
Orphan claim re-pointed
Claims processor
CLM-408400 → UHC-92935-47 (Anthony Henderson)
Member id
UHC-92935-47
Confidence
1
Method
probabilistic
MBR-005485CLM-408400
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001376
Orphan claim re-pointed
Claims processor
CLM-406632 → UHC-85810-37 (Joe Stephens)
Member id
UHC-85810-37
Confidence
0.97
Method
deterministic
MBR-004535CLM-406632
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001377
Orphan claim re-pointed
Claims processor
CLM-409676 → UHC-56059-24 (Margaret Hernandez)
Member id
UHC-56059-24
Confidence
0.97
Method
deterministic
MBR-015740CLM-409676
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001378
Orphan claim re-pointed
Claims processor
CLM-422325 → UHC-48780-72 (Lawrence Fox)
Member id
UHC-48780-72
Confidence
1
Method
probabilistic
MBR-001462CLM-422325
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001379
Orphan claim re-pointed
Claims processor
CLM-421134 → UHC-72250-82 (Amber Larson)
Member id
UHC-72250-82
Confidence
0.97
Method
probabilistic
MBR-018789CLM-421134
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001380
Orphan claim re-pointed
Claims processor
CLM-409693 → UHC-54667-79 (Christian Woods)
Member id
UHC-54667-79
Confidence
1
Method
probabilistic
MBR-015795CLM-409693
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001381
Orphan claim re-pointed
Claims processor
CLM-408783 → UHC-30243-38 (Eugene Arnold)
Member id
UHC-30243-38
Confidence
0.93
Method
probabilistic
MBR-008600CLM-408783
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001382
Orphan claim re-pointed
Claims processor
CLM-403734 → UHC-78358-58 (Gabriel Gonzalez)
Member id
UHC-78358-58
Confidence
0.99
Method
probabilistic
MBR-025958CLM-403734
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001383
Orphan claim re-pointed
Claims processor
CLM-403786 → UHC-28452-62 (Walter Luna)
Member id
UHC-28452-62
Confidence
1
Method
probabilistic
MBR-030281CLM-403786
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001384
Orphan claim re-pointed
Claims processor
CLM-416622 → UHC-22905-01 (Wayne Bailey)
Member id
UHC-22905-01
Confidence
1
Method
probabilistic
MBR-003535CLM-416622
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001385
Orphan claim re-pointed
Claims processor
CLM-415138 → UHC-25372-81 (Mei Jordan)
Member id
UHC-25372-81
Confidence
1
Method
probabilistic
MBR-021632CLM-415138
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001386
Orphan claim re-pointed
Claims processor
CLM-413215 → UHC-76989-44 (Albert Mendez)
Member id
UHC-76989-44
Confidence
0.97
Method
deterministic
MBR-034354CLM-413215
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001387
Orphan claim re-pointed
Claims processor
CLM-401686 → UHC-16393-73 (Bryan Walsh)
Member id
UHC-16393-73
Confidence
0.99
Method
probabilistic
MBR-012027CLM-401686
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001388
Orphan claim re-pointed
Claims processor
CLM-414628 → UHC-70988-35 (Alan Ellis)
Member id
UHC-70988-35
Confidence
1
Method
probabilistic
MBR-021163CLM-414628
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001389
Orphan claim re-pointed
Claims processor
CLM-412467 → UHC-25813-01 (Alexis Watkins)
Member id
UHC-25813-01
Confidence
1
Method
probabilistic
MBR-029742CLM-412467
Executed
resolution_agent
2026-10-19 19:54:39
9,112 rows, page 1 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.