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-007540
Orphan claim re-pointed
Claims processor
CLM-403551 → UHC-39760-46 (Carolyn Jackson)
Member id
UHC-39760-46
Confidence
1
Method
probabilistic
MBR-012381CLM-403551
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007541
Orphan claim re-pointed
Claims processor
CLM-426827 → UHC-23152-20 (Joe Harvey)
Member id
UHC-23152-20
Confidence
1
Method
probabilistic
MBR-018005CLM-426827
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007542
Orphan claim re-pointed
Claims processor
CLM-426825 → UHC-44713-38 (Priya Garcia)
Member id
UHC-44713-38
Confidence
1
Method
probabilistic
MBR-001698CLM-426825
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007543
Orphan claim re-pointed
Claims processor
CLM-405749 → UHC-76564-15 (Rebcca Burton)
Member id
UHC-76564-15
Confidence
0.97
Method
deterministic
MBR-024437CLM-405749
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007544
Orphan claim re-pointed
Claims processor
CLM-429113 → UHC-50353-26 (Santiago Stone)
Member id
UHC-50353-26
Confidence
1
Method
probabilistic
MBR-006505CLM-429113
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007545
Orphan claim re-pointed
Claims processor
CLM-416026 → UHC-85647-30 (Doris Anderson)
Member id
UHC-85647-30
Confidence
1
Method
probabilistic
MBR-018748CLM-416026
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007546
Orphan claim re-pointed
Claims processor
CLM-425141 → UHC-39394-36 (Priya Taylor)
Member id
UHC-39394-36
Confidence
0.99
Method
probabilistic
MBR-028656CLM-425141
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007547
Orphan claim re-pointed
Claims processor
CLM-418740 → UHC-04699-13 (Dylan Perry)
Member id
UHC-04699-13
Confidence
1
Method
probabilistic
MBR-009092CLM-418740
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007548
Orphan claim re-pointed
Claims processor
CLM-431933 → UHC-33190-68 (Austin Bradley)
Member id
UHC-33190-68
Confidence
1
Method
probabilistic
MBR-016896CLM-431933
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007549
Orphan claim re-pointed
Claims processor
CLM-406418 → UHC-61064-10 (Heather Singh)
Member id
UHC-61064-10
Confidence
1
Method
probabilistic
MBR-022902CLM-406418
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007550
Orphan claim re-pointed
Claims processor
CLM-411910 → UHC-80446-31 (Roy Vargas)
Member id
UHC-80446-31
Confidence
1
Method
probabilistic
MBR-038129CLM-411910
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007551
Orphan claim re-pointed
Claims processor
CLM-404585 → UHC-78762-82 (Maria Pierce)
Member id
UHC-78762-82
Confidence
0.97
Method
deterministic
MBR-002904CLM-404585
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007552
Orphan claim re-pointed
Claims processor
CLM-405494 → UHC-41558-85 (Lori Fowler)
Member id
UHC-41558-85
Confidence
1
Method
probabilistic
MBR-031867CLM-405494
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007553
Orphan claim re-pointed
Claims processor
CLM-425132 → UHC-46627-03 (Nicole Riley)
Member id
UHC-46627-03
Confidence
1
Method
probabilistic
MBR-000697CLM-425132
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007554
Orphan claim re-pointed
Claims processor
CLM-404248 → UHC-14129-58 (Juhn Sullivan)
Member id
UHC-14129-58
Confidence
0.97
Method
deterministic
MBR-030628CLM-404248
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007555
Orphan claim re-pointed
Claims processor
CLM-414288 → UHC-59874-28 (Raymond Lawrence)
Member id
UHC-59874-28
Confidence
1
Method
probabilistic
MBR-002648CLM-414288
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007556
Orphan claim re-pointed
Claims processor
CLM-430884 → UHC-35290-99 (Joshua Stevens)
Member id
UHC-35290-99
Confidence
1
Method
probabilistic
MBR-000158CLM-430884
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007557
Orphan claim re-pointed
Claims processor
CLM-417685 → UHC-62167-58 (Amy Evans)
Member id
UHC-62167-58
Confidence
1
Method
probabilistic
MBR-023277CLM-417685
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007558
Orphan claim re-pointed
Claims processor
CLM-432643 → UHC-47694-32 (Hiroshi Peterson)
Member id
UHC-47694-32
Confidence
1
Method
probabilistic
MBR-023429CLM-432643
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007559
Orphan claim re-pointed
Claims processor
CLM-427982 → UHC-06532-92 (Abigail Rios)
Member id
UHC-06532-92
Confidence
1
Method
probabilistic
MBR-015346CLM-427982
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007560
Orphan claim re-pointed
Claims processor
CLM-419091 → UHC-80215-67 (Frances Herrera)
Member id
UHC-80215-67
Confidence
0.99
Method
probabilistic
MBR-017402CLM-419091
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007561
Orphan claim re-pointed
Claims processor
CLM-410639 → UHC-76324-61 (Eugene Peterson)
Member id
UHC-76324-61
Confidence
1
Method
probabilistic
MBR-009427CLM-410639
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007562
Orphan claim re-pointed
Claims processor
CLM-412989 → UHC-29703-02 (Jeremy Castillo)
Member id
UHC-29703-02
Confidence
1
Method
probabilistic
MBR-016588CLM-412989
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007563
Orphan claim re-pointed
Claims processor
CLM-406640 → UHC-62854-39 (Harold Vega)
Member id
UHC-62854-39
Confidence
0.97
Method
deterministic
MBR-010727CLM-406640
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007564
Orphan claim re-pointed
Claims processor
CLM-414971 → UHC-01437-64 (Randy Freeman)
Member id
UHC-01437-64
Confidence
1
Method
probabilistic
MBR-040767CLM-414971
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007565
Orphan claim re-pointed
Claims processor
CLM-423211 → UHC-60287-08 (Elijah Wells)
Member id
UHC-60287-08
Confidence
0.97
Method
deterministic
MBR-018398CLM-423211
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007566
Orphan claim re-pointed
Claims processor
CLM-403536 → UHC-08056-64 (Joyce Wang)
Member id
UHC-08056-64
Confidence
1
Method
probabilistic
MBR-017528CLM-403536
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007567
Orphan claim re-pointed
Claims processor
CLM-408161 → UHC-40423-93 (Vincent Hayes)
Member id
UHC-40423-93
Confidence
1
Method
probabilistic
MBR-035758CLM-408161
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007568
Orphan claim re-pointed
Claims processor
CLM-414801 → UHC-97777-54 (Martha Clark)
Member id
UHC-97777-54
Confidence
0.97
Method
deterministic
MBR-038088CLM-414801
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007569
Orphan claim re-pointed
Claims processor
CLM-423141 → UHC-21870-52 (Virginia Boyd)
Member id
UHC-21870-52
Confidence
1
Method
probabilistic
MBR-006278CLM-423141
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007570
Orphan claim re-pointed
Claims processor
CLM-402273 → UHC-32066-26 (Angela Valdez)
Member id
UHC-32066-26
Confidence
1
Method
probabilistic
MBR-037119CLM-402273
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007571
Orphan claim re-pointed
Claims processor
CLM-404384 → UHC-28737-10 (Charlotte Hayes)
Member id
UHC-28737-10
Confidence
0.97
Method
deterministic
MBR-041105CLM-404384
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007572
Orphan claim re-pointed
Claims processor
CLM-404802 → UHC-90669-86 (Kyle Romero)
Member id
UHC-90669-86
Confidence
0.87
Method
probabilistic
MBR-000730CLM-404802
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007573
Orphan claim re-pointed
Claims processor
CLM-401978 → UHC-13395-79 (Tyler Guerrero)
Member id
UHC-13395-79
Confidence
1
Method
probabilistic
MBR-000090CLM-401978
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007574
Orphan claim re-pointed
Claims processor
CLM-414169 → UHC-85864-70 (Angela Espinoza)
Member id
UHC-85864-70
Confidence
1
Method
probabilistic
MBR-008417CLM-414169
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007575
Orphan claim re-pointed
Claims processor
CLM-414551 → UHC-58214-02 (Gloria Bailey)
Member id
UHC-58214-02
Confidence
1
Method
probabilistic
MBR-002937CLM-414551
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007576
Orphan claim re-pointed
Claims processor
CLM-429978 → UHC-33868-33 (Jacob Jordan)
Member id
UHC-33868-33
Confidence
1
Method
probabilistic
MBR-017144CLM-429978
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007577
Orphan claim re-pointed
Claims processor
CLM-430627 → UHC-76455-82 (Edward Hunt)
Member id
UHC-76455-82
Confidence
1
Method
probabilistic
MBR-016058CLM-430627
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007578
Orphan claim re-pointed
Claims processor
CLM-410046 → UHC-92857-60 (Sean Sean)
Member id
UHC-92857-60
Confidence
0.97
Method
deterministic
MBR-026455CLM-410046
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007579
Orphan claim re-pointed
Claims processor
CLM-428582 → UHC-92566-61 (Melissa Valdez)
Member id
UHC-92566-61
Confidence
0.97
Method
deterministic
MBR-023596CLM-428582
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007580
Orphan claim re-pointed
Claims processor
CLM-413814 → UHC-52657-16 (Sara Butler)
Member id
UHC-52657-16
Confidence
1
Method
probabilistic
MBR-014714CLM-413814
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007581
Orphan claim re-pointed
Claims processor
CLM-400701 → UHC-01302-07 (Cheryl Parker)
Member id
UHC-01302-07
Confidence
1
Method
probabilistic
MBR-002033CLM-400701
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007582
Orphan claim re-pointed
Claims processor
CLM-418788 → UHC-67519-46 (Larry Green)
Member id
UHC-67519-46
Confidence
1
Method
probabilistic
MBR-013882CLM-418788
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007583
Orphan claim re-pointed
Claims processor
CLM-411638 → UHC-84222-34 (Abigail Hill)
Member id
UHC-84222-34
Confidence
0.94
Method
probabilistic
MBR-001555CLM-411638
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007584
Orphan claim re-pointed
Claims processor
CLM-427973 → UHC-05006-39 (Christopher Obrien)
Member id
UHC-05006-39
Confidence
0.99
Method
probabilistic
MBR-019906CLM-427973
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007585
Orphan claim re-pointed
Claims processor
CLM-402769 → UHC-82117-14 (Gloria Perez)
Member id
UHC-82117-14
Confidence
1
Method
probabilistic
MBR-011144CLM-402769
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007586
Orphan claim re-pointed
Claims processor
CLM-409152 → UHC-31735-63 (Nicole Valdez)
Member id
UHC-31735-63
Confidence
1
Method
probabilistic
MBR-014680CLM-409152
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007587
Orphan claim re-pointed
Claims processor
CLM-432715 → UHC-06936-55 (Randy Riley)
Member id
UHC-06936-55
Confidence
1
Method
probabilistic
MBR-032268CLM-432715
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007588
Orphan claim re-pointed
Claims processor
CLM-407948 → UHC-33684-39 (Judy Lawrence)
Member id
UHC-33684-39
Confidence
0.97
Method
deterministic
MBR-010339CLM-407948
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007589
Orphan claim re-pointed
Claims processor
CLM-416355 → UHC-32256-98 (Bruce Phillips)
Member id
UHC-32256-98
Confidence
1
Method
probabilistic
MBR-003594CLM-416355
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 125 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.