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-007240
Orphan claim re-pointed
Claims processor
CLM-420651 → UHC-40318-84 (Christopher Russell)
Member id
UHC-40318-84
Confidence
1
Method
probabilistic
MBR-009206CLM-420651
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007241
Orphan claim re-pointed
Claims processor
CLM-409338 → UHC-15649-07 (Bryan Boyd)
Member id
UHC-15649-07
Confidence
1
Method
probabilistic
MBR-011709CLM-409338
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007242
Orphan claim re-pointed
Claims processor
CLM-405738 → UHC-43823-71 (Bobby Mason)
Member id
UHC-43823-71
Confidence
0.97
Method
deterministic
MBR-030688CLM-405738
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007243
Orphan claim re-pointed
Claims processor
CLM-407814 → UHC-02276-61 (Diane Mendez)
Member id
UHC-02276-61
Confidence
1
Method
probabilistic
MBR-033405CLM-407814
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007244
Orphan claim re-pointed
Claims processor
CLM-401451 → UHC-43441-53 (Melissa Cruz)
Member id
UHC-43441-53
Confidence
1
Method
probabilistic
MBR-017340CLM-401451
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007245
Orphan claim re-pointed
Claims processor
CLM-424994 → UHC-92278-25 (Alice Gomez)
Member id
UHC-92278-25
Confidence
1
Method
probabilistic
MBR-025189CLM-424994
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007246
Orphan claim re-pointed
Claims processor
CLM-427573 → UHC-49113-42 (Santiago Willis)
Member id
UHC-49113-42
Confidence
1
Method
probabilistic
MBR-008018CLM-427573
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007247
Orphan claim re-pointed
Claims processor
CLM-424644 → UHC-26763-55 (Vincent Sullivan)
Member id
UHC-26763-55
Confidence
1
Method
probabilistic
MBR-004927CLM-424644
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007248
Orphan claim re-pointed
Claims processor
CLM-429783 → UHC-40362-42 (Vincent Ward)
Member id
UHC-40362-42
Confidence
1
Method
probabilistic
MBR-020278CLM-429783
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007249
Orphan claim re-pointed
Claims processor
CLM-404087 → UHC-35512-91 (Jonathan Reed)
Member id
UHC-35512-91
Confidence
0.96
Method
probabilistic
MBR-029838CLM-404087
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007250
Orphan claim re-pointed
Claims processor
CLM-419522 → UHC-85777-05 (Peter Castillo)
Member id
UHC-85777-05
Confidence
1
Method
probabilistic
MBR-000993CLM-419522
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007251
Orphan claim re-pointed
Claims processor
CLM-409586 → UHC-01231-40 (Keith Schultz)
Member id
UHC-01231-40
Confidence
1
Method
probabilistic
MBR-000182CLM-409586
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007252
Orphan claim re-pointed
Claims processor
CLM-419275 → UHC-51195-87 (Kelly Espinoza)
Member id
UHC-51195-87
Confidence
1
Method
probabilistic
MBR-019030CLM-419275
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007253
Orphan claim re-pointed
Claims processor
CLM-407070 → UHC-85413-02 (Kayla Hunter)
Member id
UHC-85413-02
Confidence
1
Method
probabilistic
MBR-033437CLM-407070
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007254
Orphan claim re-pointed
Claims processor
CLM-405679 → UHC-82490-30 (Cheryl Lane)
Member id
UHC-82490-30
Confidence
1
Method
probabilistic
MBR-012925CLM-405679
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007255
Orphan claim re-pointed
Claims processor
CLM-422948 → UHC-40645-66 (Betty Evans)
Member id
UHC-40645-66
Confidence
1
Method
probabilistic
MBR-011484CLM-422948
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007256
Orphan claim re-pointed
Claims processor
CLM-403945 → UHC-24074-48 (Yuki Fox)
Member id
UHC-24074-48
Confidence
0.97
Method
deterministic
MBR-018993CLM-403945
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007257
Orphan claim re-pointed
Claims processor
CLM-419921 → UHC-65965-34 (Douglas Wang)
Member id
UHC-65965-34
Confidence
1
Method
probabilistic
MBR-008364CLM-419921
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007258
Orphan claim re-pointed
Claims processor
CLM-413785 → UHC-89247-75 (Evelyn Parker)
Member id
UHC-89247-75
Confidence
0.97
Method
deterministic
MBR-031490CLM-413785
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007259
Orphan claim re-pointed
Claims processor
CLM-418593 → UHC-97802-47 (Jessica Adams)
Member id
UHC-97802-47
Confidence
1
Method
probabilistic
MBR-009046CLM-418593
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007260
Orphan claim re-pointed
Claims processor
CLM-409738 → UHC-80139-48 (Scott Howell)
Member id
UHC-80139-48
Confidence
1
Method
probabilistic
MBR-019713CLM-409738
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007261
Orphan claim re-pointed
Claims processor
CLM-424511 → UHC-98583-63 (Bruce Cruz)
Member id
UHC-98583-63
Confidence
1
Method
probabilistic
MBR-004239CLM-424511
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007262
Orphan claim re-pointed
Claims processor
CLM-409119 → UHC-44075-78 (Joe Freeman)
Member id
UHC-44075-78
Confidence
0.97
Method
deterministic
MBR-002013CLM-409119
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007263
Orphan claim re-pointed
Claims processor
CLM-413835 → UHC-41599-44 (Sean Andrews)
Member id
UHC-41599-44
Confidence
1
Method
probabilistic
MBR-007280CLM-413835
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007264
Orphan claim re-pointed
Claims processor
CLM-408406 → UHC-34872-28 (Marilyn Meyer)
Member id
UHC-34872-28
Confidence
0.97
Method
deterministic
MBR-021650CLM-408406
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007265
Orphan claim re-pointed
Claims processor
CLM-428291 → UHC-42317-04 (Hannah Harris)
Member id
UHC-42317-04
Confidence
1
Method
probabilistic
MBR-013062CLM-428291
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007266
Orphan claim re-pointed
Claims processor
CLM-405347 → UHC-54937-27 (Bryan Stevens)
Member id
UHC-54937-27
Confidence
0.87
Method
probabilistic
MBR-003269CLM-405347
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007267
Orphan claim re-pointed
Claims processor
CLM-428614 → UHC-45580-06 (Andrea Harvey)
Member id
UHC-45580-06
Confidence
0.97
Method
deterministic
MBR-027335CLM-428614
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007268
Orphan claim re-pointed
Claims processor
CLM-409982 → UHC-00347-08 (Stephen McCoy)
Member id
UHC-00347-08
Confidence
1
Method
probabilistic
MBR-005747CLM-409982
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007269
Orphan claim re-pointed
Claims processor
CLM-417946 → UHC-16646-65 (Kevin Cunningham)
Member id
UHC-16646-65
Confidence
1
Method
probabilistic
MBR-025383CLM-417946
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007270
Orphan claim re-pointed
Claims processor
CLM-420433 → UHC-96057-46 (Helen Dominguez)
Member id
UHC-96057-46
Confidence
1
Method
probabilistic
MBR-002246CLM-420433
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007271
Orphan claim re-pointed
Claims processor
CLM-429333 → UHC-82530-02 (Barbara Kennedy)
Member id
UHC-82530-02
Confidence
0.93
Method
probabilistic
MBR-027012CLM-429333
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007272
Orphan claim re-pointed
Claims processor
CLM-432252 → UHC-95527-11 (Catherine Romero)
Member id
UHC-95527-11
Confidence
1
Method
probabilistic
MBR-013621CLM-432252
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007273
Orphan claim re-pointed
Claims processor
CLM-423436 → UHC-53888-91 (Brittany Henderson)
Member id
UHC-53888-91
Confidence
1
Method
probabilistic
MBR-003449CLM-423436
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007274
Orphan claim re-pointed
Claims processor
CLM-424032 → UHC-45400-47 (Megan Kim)
Member id
UHC-45400-47
Confidence
1
Method
probabilistic
MBR-008181CLM-424032
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007275
Orphan claim re-pointed
Claims processor
CLM-402719 → UHC-36910-73 (Marcus Marshall)
Member id
UHC-36910-73
Confidence
1
Method
probabilistic
MBR-008647CLM-402719
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007276
Orphan claim re-pointed
Claims processor
CLM-404430 → UHC-89708-54 (Jonathan Turner)
Member id
UHC-89708-54
Confidence
1
Method
probabilistic
MBR-012906CLM-404430
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007277
Orphan claim re-pointed
Claims processor
CLM-423449 → UHC-88391-59 (Lauren Sandoval)
Member id
UHC-88391-59
Confidence
0.97
Method
deterministic
MBR-005587CLM-423449
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007278
Orphan claim re-pointed
Claims processor
CLM-428014 → UHC-08220-88 (Terry Perkins)
Member id
UHC-08220-88
Confidence
1
Method
probabilistic
MBR-023347CLM-428014
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007279
Orphan claim re-pointed
Claims processor
CLM-409135 → UHC-69964-16 (Jacqueline Turner)
Member id
UHC-69964-16
Confidence
0.99
Method
probabilistic
MBR-005263CLM-409135
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007280
Orphan claim re-pointed
Claims processor
CLM-415868 → UHC-03787-87 (Noah Burton)
Member id
UHC-03787-87
Confidence
1
Method
probabilistic
MBR-024007CLM-415868
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007281
Orphan claim re-pointed
Claims processor
CLM-403524 → UHC-31813-40 (Joseph Wang)
Member id
UHC-31813-40
Confidence
1
Method
probabilistic
MBR-023657CLM-403524
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007282
Orphan claim re-pointed
Claims processor
CLM-428310 → UHC-89807-12 (Joseph Collins)
Member id
UHC-89807-12
Confidence
1
Method
probabilistic
MBR-007961CLM-428310
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007283
Orphan claim re-pointed
Claims processor
CLM-416020 → UHC-49073-83 (Fatima Butler)
Member id
UHC-49073-83
Confidence
1
Method
probabilistic
MBR-014985CLM-416020
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007284
Orphan claim re-pointed
Claims processor
CLM-418396 → UHC-84939-80 (Helen Oliver)
Member id
UHC-84939-80
Confidence
1
Method
probabilistic
MBR-035650CLM-418396
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007285
Orphan claim re-pointed
Claims processor
CLM-414377 → UHC-99048-06 (Luis Gonzales)
Member id
UHC-99048-06
Confidence
0.97
Method
deterministic
MBR-031801CLM-414377
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007286
Orphan claim re-pointed
Claims processor
CLM-419545 → UHC-63508-30 (Zachary Evans)
Member id
UHC-63508-30
Confidence
0.93
Method
probabilistic
MBR-001637CLM-419545
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007287
Orphan claim re-pointed
Claims processor
CLM-418804 → UHC-16032-64 (Melissa Moreno)
Member id
UHC-16032-64
Confidence
1
Method
probabilistic
MBR-007491CLM-418804
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007288
Orphan claim re-pointed
Claims processor
CLM-402325 → UHC-19887-42 (Sophia Carter)
Member id
UHC-19887-42
Confidence
1
Method
probabilistic
MBR-011401CLM-402325
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007289
Orphan claim re-pointed
Claims processor
CLM-432653 → UHC-21594-17 (Stephen Watkins)
Member id
UHC-21594-17
Confidence
0.97
Method
deterministic
MBR-016003CLM-432653
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 119 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.