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-007140
Orphan claim re-pointed
Claims processor
CLM-427826 → UHC-34630-48 (Natalie Morgan)
Member id
UHC-34630-48
Confidence
1
Method
probabilistic
MBR-014686CLM-427826
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007141
Orphan claim re-pointed
Claims processor
CLM-404948 → UHC-22461-47 (Nicole Rice)
Member id
UHC-22461-47
Confidence
1
Method
probabilistic
MBR-027225CLM-404948
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007142
Orphan claim re-pointed
Claims processor
CLM-416033 → UHC-60936-79 (Marcus Tucker)
Member id
UHC-60936-79
Confidence
0.97
Method
deterministic
MBR-016840CLM-416033
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007143
Orphan claim re-pointed
Claims processor
CLM-414864 → UHC-21871-27 (Scott Gibson)
Member id
UHC-21871-27
Confidence
0.99
Method
probabilistic
MBR-007489CLM-414864
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007144
Orphan claim re-pointed
Claims processor
CLM-429404 → UHC-79908-24 (Edward Edwards)
Member id
UHC-79908-24
Confidence
1
Method
probabilistic
MBR-025267CLM-429404
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007145
Orphan claim re-pointed
Claims processor
CLM-431415 → UHC-36403-64 (Carolyn Richards)
Member id
UHC-36403-64
Confidence
1
Method
probabilistic
MBR-009251CLM-431415
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007146
Orphan claim re-pointed
Claims processor
CLM-429571 → UHC-15588-86 (Jonathan Bryant)
Member id
UHC-15588-86
Confidence
0.97
Method
deterministic
MBR-027308CLM-429571
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007147
Orphan claim re-pointed
Claims processor
CLM-411861 → UHC-91260-88 (Nathan Olson)
Member id
UHC-91260-88
Confidence
1
Method
probabilistic
MBR-015953CLM-411861
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007148
Orphan claim re-pointed
Claims processor
CLM-422238 → UHC-26322-25 (Joseph Daniels)
Member id
UHC-26322-25
Confidence
0.97
Method
deterministic
MBR-009793CLM-422238
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007149
Orphan claim re-pointed
Claims processor
CLM-409219 → UHC-91184-90 (Vincent Gomez)
Member id
UHC-91184-90
Confidence
1
Method
probabilistic
MBR-025742CLM-409219
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007150
Orphan claim re-pointed
Claims processor
CLM-400467 → UHC-08752-97 (Wayne Carpenter)
Member id
UHC-08752-97
Confidence
1
Method
probabilistic
MBR-019707CLM-400467
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007151
Orphan claim re-pointed
Claims processor
CLM-422759 → UHC-13607-07 (Lucia Washington)
Member id
UHC-13607-07
Confidence
1
Method
probabilistic
MBR-023555CLM-422759
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007152
Orphan claim re-pointed
Claims processor
CLM-414124 → UHC-62683-57 (Deborah Burke)
Member id
UHC-62683-57
Confidence
0.99
Method
probabilistic
MBR-032773CLM-414124
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007153
Orphan claim re-pointed
Claims processor
CLM-418631 → UHC-31856-02 (Anthony Fields)
Member id
UHC-31856-02
Confidence
0.98
Method
probabilistic
MBR-031536CLM-418631
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007154
Orphan claim re-pointed
Claims processor
CLM-400877 → UHC-77734-83 (Justin Gordon)
Member id
UHC-77734-83
Confidence
1
Method
probabilistic
MBR-018708CLM-400877
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007155
Orphan claim re-pointed
Claims processor
CLM-413839 → UHC-21374-40 (Dylan Rivera)
Member id
UHC-21374-40
Confidence
1
Method
probabilistic
MBR-016240CLM-413839
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007156
Orphan claim re-pointed
Claims processor
CLM-406757 → UHC-77796-83 (Eugene Elliott)
Member id
UHC-77796-83
Confidence
1
Method
probabilistic
MBR-019649CLM-406757
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007157
Orphan claim re-pointed
Claims processor
CLM-423264 → UHC-68621-79 (Raymond Snyder)
Member id
UHC-68621-79
Confidence
1
Method
probabilistic
MBR-007154CLM-423264
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007158
Orphan claim re-pointed
Claims processor
CLM-425555 → UHC-98623-51 (Kelly Wallace)
Member id
UHC-98623-51
Confidence
1
Method
probabilistic
MBR-015279CLM-425555
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007159
Orphan claim re-pointed
Claims processor
CLM-425310 → UHC-46569-38 (Arthur Carter)
Member id
UHC-46569-38
Confidence
1
Method
probabilistic
MBR-012911CLM-425310
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007160
Orphan claim re-pointed
Claims processor
CLM-421385 → UHC-60404-50 (Diae Nguyen)
Member id
UHC-60404-50
Confidence
0.98
Method
probabilistic
MBR-004786CLM-421385
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007161
Orphan claim re-pointed
Claims processor
CLM-406490 → UHC-95967-21 (Ralph Nguyen)
Member id
UHC-95967-21
Confidence
1
Method
probabilistic
MBR-013755CLM-406490
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007162
Orphan claim re-pointed
Claims processor
CLM-431314 → UHC-94844-47 (Joshua Guerrero)
Member id
UHC-94844-47
Confidence
1
Method
probabilistic
MBR-004457CLM-431314
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007163
Orphan claim re-pointed
Claims processor
CLM-410922 → UHC-67960-13 (Dylan Pierce)
Member id
UHC-67960-13
Confidence
1
Method
probabilistic
MBR-038060CLM-410922
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007164
Orphan claim re-pointed
Claims processor
CLM-416398 → UHC-37033-56 (Logan Wang)
Member id
UHC-37033-56
Confidence
1
Method
probabilistic
MBR-032389CLM-416398
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007165
Orphan claim re-pointed
Claims processor
CLM-424661 → UHC-50017-20 (Henry Jackson)
Member id
UHC-50017-20
Confidence
0.93
Method
probabilistic
MBR-021242CLM-424661
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007166
Orphan claim re-pointed
Claims processor
CLM-426737 → UHC-09236-74 (Juan Carroll)
Member id
UHC-09236-74
Confidence
0.97
Method
deterministic
MBR-022119CLM-426737
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007167
Orphan claim re-pointed
Claims processor
CLM-417057 → UHC-92848-17 (Lauren Simpson)
Member id
UHC-92848-17
Confidence
1
Method
probabilistic
MBR-006093CLM-417057
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007168
Orphan claim re-pointed
Claims processor
CLM-420580 → UHC-97273-56 (Sandra Long)
Member id
UHC-97273-56
Confidence
0.87
Method
probabilistic
MBR-030165CLM-420580
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007169
Orphan claim re-pointed
Claims processor
CLM-404845 → UHC-47377-58 (Joseph Stevens)
Member id
UHC-47377-58
Confidence
1
Method
probabilistic
MBR-019921CLM-404845
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007170
Orphan claim re-pointed
Claims processor
CLM-417579 → UHC-16030-05 (Henry Graham)
Member id
UHC-16030-05
Confidence
1
Method
probabilistic
MBR-003205CLM-417579
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007171
Orphan claim re-pointed
Claims processor
CLM-420293 → UHC-33964-60 (Christian Lopez)
Member id
UHC-33964-60
Confidence
0.97
Method
deterministic
MBR-016854CLM-420293
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007172
Orphan claim re-pointed
Claims processor
CLM-406724 → UHC-04666-05 (Kenneth Hunter)
Member id
UHC-04666-05
Confidence
1
Method
probabilistic
MBR-014019CLM-406724
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007173
Orphan claim re-pointed
Claims processor
CLM-428802 → UHC-96293-11 (Edward Simpson)
Member id
UHC-96293-11
Confidence
1
Method
probabilistic
MBR-005586CLM-428802
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007174
Orphan claim re-pointed
Claims processor
CLM-418939 → UHC-28850-11 (Helen Johnson)
Member id
UHC-28850-11
Confidence
1
Method
probabilistic
MBR-008140CLM-418939
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007175
Orphan claim re-pointed
Claims processor
CLM-425230 → UHC-02912-63 (Bradley Cole)
Member id
UHC-02912-63
Confidence
0.97
Method
deterministic
MBR-030052CLM-425230
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007176
Orphan claim re-pointed
Claims processor
CLM-420711 → UHC-90571-84 (Kathleen Castillo)
Member id
UHC-90571-84
Confidence
0.97
Method
deterministic
MBR-015556CLM-420711
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007177
Orphan claim re-pointed
Claims processor
CLM-402397 → UHC-29381-35 (Hannah Ryan)
Member id
UHC-29381-35
Confidence
0.97
Method
deterministic
MBR-031343CLM-402397
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007178
Orphan claim re-pointed
Claims processor
CLM-423015 → UHC-11528-25 (Isabella Watson)
Member id
UHC-11528-25
Confidence
1
Method
probabilistic
MBR-005561CLM-423015
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007179
Orphan claim re-pointed
Claims processor
CLM-414529 → UHC-91573-67 (Bryan Anderson)
Member id
UHC-91573-67
Confidence
0.97
Method
deterministic
MBR-019573CLM-414529
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007180
Orphan claim re-pointed
Claims processor
CLM-423437 → UHC-21091-76 (Stephen Weber)
Member id
UHC-21091-76
Confidence
1
Method
probabilistic
MBR-018455CLM-423437
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007181
Orphan claim re-pointed
Claims processor
CLM-426874 → UHC-95535-50 (Henry Watson)
Member id
UHC-95535-50
Confidence
1
Method
probabilistic
MBR-006448CLM-426874
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007182
Orphan claim re-pointed
Claims processor
CLM-411106 → UHC-89861-37 (Nancy Evans)
Member id
UHC-89861-37
Confidence
1
Method
probabilistic
MBR-001210CLM-411106
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007183
Orphan claim re-pointed
Claims processor
CLM-407951 → UHC-27499-03 (Rachel Rose)
Member id
UHC-27499-03
Confidence
0.85
Method
probabilistic
MBR-003937CLM-407951
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007184
Orphan claim re-pointed
Claims processor
CLM-404429 → UHC-17367-62 (John Morris)
Member id
UHC-17367-62
Confidence
1
Method
probabilistic
MBR-017226CLM-404429
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007185
Orphan claim re-pointed
Claims processor
CLM-404199 → UHC-10156-16 (Debra Lawson)
Member id
UHC-10156-16
Confidence
0.97
Method
deterministic
MBR-003558CLM-404199
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007186
Orphan claim re-pointed
Claims processor
CLM-413134 → UHC-10198-70 (Marilyn Aguilar)
Member id
UHC-10198-70
Confidence
1
Method
probabilistic
MBR-008183CLM-413134
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007187
Orphan claim re-pointed
Claims processor
CLM-411822 → UHC-15101-05 (Vincent Jones)
Member id
UHC-15101-05
Confidence
1
Method
probabilistic
MBR-008664CLM-411822
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007188
Orphan claim re-pointed
Claims processor
CLM-417410 → UHC-74389-69 (Robert Soto)
Member id
UHC-74389-69
Confidence
0.97
Method
deterministic
MBR-045103CLM-417410
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007189
Orphan claim re-pointed
Claims processor
CLM-425680 → UHC-89493-86 (Janet Mejia)
Member id
UHC-89493-86
Confidence
1
Method
probabilistic
MBR-022653CLM-425680
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 117 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.