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

TypeAllEligibility conflict resolved1,339Orphan claim re-pointed9,112Outreach address corrected2,993Outreach suppressed pending steward4,326Care coordination outreach1,815New member onboarding2,081Duplicate member record retired4,974
StatusAllProposed8,228Executed14,086Held4,326Released0
ActionTypeTitleDetailLinked toStatusExecuted
ACT-001790
Orphan claim re-pointed
Claims processor
CLM-416278 → UHC-61491-38 (Carlos Kennedy)
Member id
UHC-61491-38
Confidence
0.99
Method
probabilistic
MBR-005824CLM-416278
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001791
Orphan claim re-pointed
Claims processor
CLM-426549 → UHC-75623-64 (Amanda Hill)
Member id
UHC-75623-64
Confidence
1
Method
probabilistic
MBR-016312CLM-426549
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001792
Orphan claim re-pointed
Claims processor
CLM-401714 → UHC-52048-24 (Andrea Holmes)
Member id
UHC-52048-24
Confidence
0.97
Method
deterministic
MBR-001288CLM-401714
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001793
Orphan claim re-pointed
Claims processor
CLM-415544 → UHC-61925-07 (Eugene Roberts)
Member id
UHC-61925-07
Confidence
1
Method
probabilistic
MBR-019238CLM-415544
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001794
Orphan claim re-pointed
Claims processor
CLM-424802 → UHC-99900-84 (Isabella Collins)
Member id
UHC-99900-84
Confidence
0.93
Method
probabilistic
MBR-027593CLM-424802
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001795
Orphan claim re-pointed
Claims processor
CLM-411640 → UHC-48356-13 (Anna Dominguez)
Member id
UHC-48356-13
Confidence
0.97
Method
deterministic
MBR-038920CLM-411640
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001796
Orphan claim re-pointed
Claims processor
CLM-425136 → UHC-65778-19 (Hiroshi Carter)
Member id
UHC-65778-19
Confidence
0.97
Method
deterministic
MBR-017140CLM-425136
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001797
Orphan claim re-pointed
Claims processor
CLM-417915 → UHC-78083-57 (Judith West)
Member id
UHC-78083-57
Confidence
1
Method
probabilistic
MBR-012031CLM-417915
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001798
Orphan claim re-pointed
Claims processor
CLM-428764 → UHC-27150-81 (Elizabeth Rose)
Member id
UHC-27150-81
Confidence
1
Method
probabilistic
MBR-004408CLM-428764
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001799
Orphan claim re-pointed
Claims processor
CLM-411367 → UHC-72162-77 (Jonathan Wheelar)
Member id
UHC-72162-77
Confidence
0.91
Method
probabilistic
MBR-007930CLM-411367
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001800
Orphan claim re-pointed
Claims processor
CLM-424869 → UHC-50104-81 (Nancy Mills)
Member id
UHC-50104-81
Confidence
0.99
Method
probabilistic
MBR-025449CLM-424869
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001801
Orphan claim re-pointed
Claims processor
CLM-419408 → UHC-41975-39 (Mary Torres)
Member id
UHC-41975-39
Confidence
1
Method
probabilistic
MBR-008793CLM-419408
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001802
Orphan claim re-pointed
Claims processor
CLM-422623 → UHC-08895-06 (Sofia Mitchell)
Member id
UHC-08895-06
Confidence
1
Method
probabilistic
MBR-010078CLM-422623
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001803
Orphan claim re-pointed
Claims processor
CLM-432356 → UHC-07217-33 (Roy James)
Member id
UHC-07217-33
Confidence
1
Method
probabilistic
MBR-019822CLM-432356
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001804
Orphan claim re-pointed
Claims processor
CLM-421438 → UHC-45310-05 (Peter Ferguson)
Member id
UHC-45310-05
Confidence
1
Method
probabilistic
MBR-008428CLM-421438
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001805
Orphan claim re-pointed
Claims processor
CLM-409592 → UHC-46398-33 (Evelyn Olson)
Member id
UHC-46398-33
Confidence
1
Method
probabilistic
MBR-014138CLM-409592
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001806
Orphan claim re-pointed
Claims processor
CLM-404459 → UHC-48249-92 (Kelly Baker)
Member id
UHC-48249-92
Confidence
1
Method
probabilistic
MBR-000761CLM-404459
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001807
Orphan claim re-pointed
Claims processor
CLM-426951 → UHC-06715-98 (Karen Powell)
Member id
UHC-06715-98
Confidence
1
Method
probabilistic
MBR-006911CLM-426951
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001808
Orphan claim re-pointed
Claims processor
CLM-422007 → UHC-67569-41 (Ruth Sandoval)
Member id
UHC-67569-41
Confidence
0.97
Method
deterministic
MBR-016803CLM-422007
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001809
Orphan claim re-pointed
Claims processor
CLM-421899 → UHC-80433-48 (Alexis Price)
Member id
UHC-80433-48
Confidence
1
Method
probabilistic
MBR-025040CLM-421899
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001810
Orphan claim re-pointed
Claims processor
CLM-410413 → UHC-67055-02 (Fatima Nunez)
Member id
UHC-67055-02
Confidence
0.97
Method
deterministic
MBR-018025CLM-410413
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001811
Orphan claim re-pointed
Claims processor
CLM-417860 → UHC-67304-99 (Kevin Walker)
Member id
UHC-67304-99
Confidence
1
Method
probabilistic
MBR-001569CLM-417860
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001812
Orphan claim re-pointed
Claims processor
CLM-411493 → UHC-44996-73 (Gerald Marquez)
Member id
UHC-44996-73
Confidence
1
Method
probabilistic
MBR-000053CLM-411493
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001813
Orphan claim re-pointed
Claims processor
CLM-412813 → UHC-66814-69 (Camila Baker)
Member id
UHC-66814-69
Confidence
1
Method
probabilistic
MBR-026210CLM-412813
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001814
Orphan claim re-pointed
Claims processor
CLM-406027 → UHC-17618-84 (Douglas Sandoval)
Member id
UHC-17618-84
Confidence
1
Method
probabilistic
MBR-012088CLM-406027
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001815
Orphan claim re-pointed
Claims processor
CLM-428304 → UHC-96551-62 (Janice Sto)
Member id
UHC-96551-62
Confidence
0.97
Method
probabilistic
MBR-012615CLM-428304
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001816
Orphan claim re-pointed
Claims processor
CLM-417139 → UHC-27455-47 (Daniel Cooper)
Member id
UHC-27455-47
Confidence
1
Method
probabilistic
MBR-007838CLM-417139
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001817
Orphan claim re-pointed
Claims processor
CLM-404352 → UHC-42414-79 (Pamela Contreras)
Member id
UHC-42414-79
Confidence
1
Method
probabilistic
MBR-020148CLM-404352
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001818
Orphan claim re-pointed
Claims processor
CLM-412244 → UHC-40023-82 (Victoria Ross)
Member id
UHC-40023-82
Confidence
1.00
Method
probabilistic
MBR-007791CLM-412244
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001819
Orphan claim re-pointed
Claims processor
CLM-406055 → UHC-83119-24 (Hannah Green)
Member id
UHC-83119-24
Confidence
1
Method
probabilistic
MBR-023472CLM-406055
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001820
Orphan claim re-pointed
Claims processor
CLM-406954 → UHC-12897-50 (Kevin Jacobs)
Member id
UHC-12897-50
Confidence
1
Method
probabilistic
MBR-012297CLM-406954
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001821
Orphan claim re-pointed
Claims processor
CLM-419205 → UHC-74235-33 (Charlotte Burns)
Member id
UHC-74235-33
Confidence
0.97
Method
deterministic
MBR-004075CLM-419205
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001822
Orphan claim re-pointed
Claims processor
CLM-408396 → UHC-43018-83 (Jacqueline Grant)
Member id
UHC-43018-83
Confidence
1
Method
probabilistic
MBR-013002CLM-408396
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001823
Orphan claim re-pointed
Claims processor
CLM-419943 → UHC-60747-77 (Robert Price)
Member id
UHC-60747-77
Confidence
0.97
Method
deterministic
MBR-002869CLM-419943
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001824
Orphan claim re-pointed
Claims processor
CLM-401442 → UHC-13842-70 (Daniel Lee)
Member id
UHC-13842-70
Confidence
0.98
Method
probabilistic
MBR-018143CLM-401442
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001825
Orphan claim re-pointed
Claims processor
CLM-400048 → UHC-03918-71 (Doris Garza)
Member id
UHC-03918-71
Confidence
1
Method
probabilistic
MBR-018718CLM-400048
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001826
Orphan claim re-pointed
Claims processor
CLM-429879 → UHC-64751-19 (Julie Pena)
Member id
UHC-64751-19
Confidence
0.97
Method
deterministic
MBR-025241CLM-429879
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001827
Orphan claim re-pointed
Claims processor
CLM-420590 → UHC-54455-12 (Emma Sanders)
Member id
UHC-54455-12
Confidence
1
Method
probabilistic
MBR-021491CLM-420590
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001828
Orphan claim re-pointed
Claims processor
CLM-430896 → UHC-92970-85 (Valentina Reid)
Member id
UHC-92970-85
Confidence
1
Method
probabilistic
MBR-004776CLM-430896
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001829
Orphan claim re-pointed
Claims processor
CLM-428988 → UHC-73011-94 (Walter Payne)
Member id
UHC-73011-94
Confidence
1
Method
probabilistic
MBR-025412CLM-428988
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001830
Orphan claim re-pointed
Claims processor
CLM-412649 → UHC-69097-81 (Janet Young)
Member id
UHC-69097-81
Confidence
1
Method
probabilistic
MBR-006630CLM-412649
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001831
Orphan claim re-pointed
Claims processor
CLM-419510 → UHC-81159-03 (Angela Flores)
Member id
UHC-81159-03
Confidence
1
Method
probabilistic
MBR-005357CLM-419510
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001832
Orphan claim re-pointed
Claims processor
CLM-412398 → UHC-73546-71 (Scott Gilbert)
Member id
UHC-73546-71
Confidence
1
Method
probabilistic
MBR-008989CLM-412398
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001833
Orphan claim re-pointed
Claims processor
CLM-425581 → UHC-07621-24 (Douglas Gutierrez)
Member id
UHC-07621-24
Confidence
1
Method
probabilistic
MBR-024934CLM-425581
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001834
Orphan claim re-pointed
Claims processor
CLM-409817 → UHC-52639-41 (Hiroshi Rice)
Member id
UHC-52639-41
Confidence
0.97
Method
deterministic
MBR-004166CLM-409817
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001835
Orphan claim re-pointed
Claims processor
CLM-403920 → UHC-05862-91 (Zachary Carlson)
Member id
UHC-05862-91
Confidence
1
Method
probabilistic
MBR-008576CLM-403920
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001836
Orphan claim re-pointed
Claims processor
CLM-411231 → UHC-89373-58 (Camila Turner)
Member id
UHC-89373-58
Confidence
1
Method
probabilistic
MBR-033209CLM-411231
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001837
Orphan claim re-pointed
Claims processor
CLM-411494 → UHC-29390-48 (Kayla Carr)
Member id
UHC-29390-48
Confidence
0.99
Method
probabilistic
MBR-020420CLM-411494
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001838
Orphan claim re-pointed
Claims processor
CLM-415319 → UHC-55250-97 (Andrea Black)
Member id
UHC-55250-97
Confidence
0.97
Method
deterministic
MBR-022440CLM-415319
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001839
Orphan claim re-pointed
Claims processor
CLM-409450 → UHC-21212-52 (Rachel Walker)
Member id
UHC-21212-52
Confidence
0.93
Method
probabilistic
MBR-011146CLM-409450
Executed
resolution_agent
2026-10-19 19:54:39
14,086 rows, page 10 of 282PreviousNext

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.