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-007640
Orphan claim re-pointed
Claims processor
CLM-430597 → UHC-39448-14 (Nicholas Lee)
Member id
UHC-39448-14
Confidence
0.97
Method
deterministic
MBR-006952CLM-430597
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007641
Orphan claim re-pointed
Claims processor
CLM-412897 → UHC-32595-69 (Gregory Delgado)
Member id
UHC-32595-69
Confidence
1
Method
probabilistic
MBR-006263CLM-412897
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007642
Orphan claim re-pointed
Claims processor
CLM-430725 → UHC-21577-09 (Hiroshi Wright)
Member id
UHC-21577-09
Confidence
1
Method
probabilistic
MBR-033092CLM-430725
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007643
Orphan claim re-pointed
Claims processor
CLM-430496 → UHC-17406-73 (Sean Schmidt)
Member id
UHC-17406-73
Confidence
1
Method
probabilistic
MBR-013381CLM-430496
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007644
Orphan claim re-pointed
Claims processor
CLM-420658 → UHC-30457-37 (Melissa Hansen)
Member id
UHC-30457-37
Confidence
1
Method
probabilistic
MBR-001994CLM-420658
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007645
Orphan claim re-pointed
Claims processor
CLM-403585 → UHC-23311-92 (Luis Ramos)
Member id
UHC-23311-92
Confidence
1
Method
probabilistic
MBR-018882CLM-403585
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007646
Orphan claim re-pointed
Claims processor
CLM-409630 → UHC-66081-91 (Edward Matthews)
Member id
UHC-66081-91
Confidence
1
Method
probabilistic
MBR-029844CLM-409630
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007647
Orphan claim re-pointed
Claims processor
CLM-404855 → UHC-25052-40 (Bobby Romero)
Member id
UHC-25052-40
Confidence
1
Method
probabilistic
MBR-043086CLM-404855
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007648
Orphan claim re-pointed
Claims processor
CLM-404952 → UHC-57723-01 (Logan Tucker)
Member id
UHC-57723-01
Confidence
1
Method
probabilistic
MBR-027792CLM-404952
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007649
Orphan claim re-pointed
Claims processor
CLM-422614 → UHC-83650-20 (Justin McDonald)
Member id
UHC-83650-20
Confidence
1
Method
probabilistic
MBR-028723CLM-422614
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007650
Orphan claim re-pointed
Claims processor
CLM-430417 → UHC-71193-02 (Valentina Guerrero)
Member id
UHC-71193-02
Confidence
1
Method
probabilistic
MBR-028670CLM-430417
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007651
Orphan claim re-pointed
Claims processor
CLM-421426 → UHC-79685-07 (Aisha Bowman)
Member id
UHC-79685-07
Confidence
0.97
Method
deterministic
MBR-014389CLM-421426
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007652
Orphan claim re-pointed
Claims processor
CLM-404033 → UHC-10810-94 (Kyle Simpson)
Member id
UHC-10810-94
Confidence
0.97
Method
deterministic
MBR-027999CLM-404033
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007653
Orphan claim re-pointed
Claims processor
CLM-404340 → UHC-95183-75 (Madison Armstrong)
Member id
UHC-95183-75
Confidence
1
Method
probabilistic
MBR-004451CLM-404340
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007654
Orphan claim re-pointed
Claims processor
CLM-414707 → UHC-65778-87 (Sophia Perez)
Member id
UHC-65778-87
Confidence
0.97
Method
probabilistic
MBR-007871CLM-414707
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007655
Orphan claim re-pointed
Claims processor
CLM-411717 → UHC-60815-26 (Alexander Bradley)
Member id
UHC-60815-26
Confidence
1
Method
probabilistic
MBR-000953CLM-411717
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007656
Orphan claim re-pointed
Claims processor
CLM-402883 → UHC-60636-14 (Diana Evans)
Member id
UHC-60636-14
Confidence
1
Method
probabilistic
MBR-012744CLM-402883
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007657
Orphan claim re-pointed
Claims processor
CLM-412310 → UHC-81920-75 (Logan Salazar)
Member id
UHC-81920-75
Confidence
0.99
Method
probabilistic
MBR-017096CLM-412310
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007658
Orphan claim re-pointed
Claims processor
CLM-407711 → UHC-26872-91 (Natalie Wagner)
Member id
UHC-26872-91
Confidence
1
Method
probabilistic
MBR-009288CLM-407711
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007659
Orphan claim re-pointed
Claims processor
CLM-414674 → UHC-80386-84 (Rachel Ray)
Member id
UHC-80386-84
Confidence
0.97
Method
deterministic
MBR-028717CLM-414674
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007660
Orphan claim re-pointed
Claims processor
CLM-415245 → UHC-89426-04 (Jeremy Vegga)
Member id
UHC-89426-04
Confidence
0.99
Method
probabilistic
MBR-012839CLM-415245
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007661
Orphan claim re-pointed
Claims processor
CLM-408580 → UHC-81413-97 (Kelly Flores)
Member id
UHC-81413-97
Confidence
0.97
Method
deterministic
MBR-044084CLM-408580
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007662
Orphan claim re-pointed
Claims processor
CLM-418872 → UHC-79380-69 (Joseph Carpenter)
Member id
UHC-79380-69
Confidence
0.97
Method
deterministic
MBR-003817CLM-418872
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007663
Orphan claim re-pointed
Claims processor
CLM-419313 → UHC-83325-61 (Virginia Harper)
Member id
UHC-83325-61
Confidence
1
Method
probabilistic
MBR-003891CLM-419313
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007664
Orphan claim re-pointed
Claims processor
CLM-415761 → UHC-91168-07 (Emily Fuller)
Member id
UHC-91168-07
Confidence
1
Method
probabilistic
MBR-000376CLM-415761
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007665
Orphan claim re-pointed
Claims processor
CLM-431523 → UHC-96267-36 (Christina Rios)
Member id
UHC-96267-36
Confidence
0.97
Method
deterministic
MBR-023165CLM-431523
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007666
Orphan claim re-pointed
Claims processor
CLM-405177 → UHC-83774-86 (Mariana Carlson)
Member id
UHC-83774-86
Confidence
0.97
Method
deterministic
MBR-021208CLM-405177
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007667
Orphan claim re-pointed
Claims processor
CLM-419439 → UHC-90187-32 (Adam Henry)
Member id
UHC-90187-32
Confidence
1
Method
probabilistic
MBR-008669CLM-419439
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007668
Orphan claim re-pointed
Claims processor
CLM-413206 → UHC-96439-17 (Danielle Peterson)
Member id
UHC-96439-17
Confidence
0.97
Method
deterministic
MBR-009177CLM-413206
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007669
Orphan claim re-pointed
Claims processor
CLM-421706 → UHC-15406-67 (Aisha Bishop)
Member id
UHC-15406-67
Confidence
1
Method
probabilistic
MBR-022283CLM-421706
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007670
Orphan claim re-pointed
Claims processor
CLM-405087 → UHC-66627-67 (Janice Cox)
Member id
UHC-66627-67
Confidence
1
Method
probabilistic
MBR-010743CLM-405087
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007671
Orphan claim re-pointed
Claims processor
CLM-419028 → UHC-54434-24 (Natalie Ramos)
Member id
UHC-54434-24
Confidence
1
Method
probabilistic
MBR-001151CLM-419028
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007672
Orphan claim re-pointed
Claims processor
CLM-416698 → UHC-75227-62 (Luis Delgado)
Member id
UHC-75227-62
Confidence
1
Method
probabilistic
MBR-030893CLM-416698
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007673
Orphan claim re-pointed
Claims processor
CLM-424154 → UHC-78452-70 (Joshua Vasquez)
Member id
UHC-78452-70
Confidence
0.97
Method
deterministic
MBR-015340CLM-424154
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007674
Orphan claim re-pointed
Claims processor
CLM-418831 → UHC-95582-35 (Jose Richards)
Member id
UHC-95582-35
Confidence
1
Method
probabilistic
MBR-029923CLM-418831
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007675
Orphan claim re-pointed
Claims processor
CLM-414116 → UHC-18539-67 (Paul Gilbert)
Member id
UHC-18539-67
Confidence
1
Method
probabilistic
MBR-008812CLM-414116
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007676
Orphan claim re-pointed
Claims processor
CLM-431735 → UHC-18114-77 (Arthur Valdez)
Member id
UHC-18114-77
Confidence
1
Method
probabilistic
MBR-022227CLM-431735
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007677
Orphan claim re-pointed
Claims processor
CLM-423790 → UHC-79179-52 (Dennis Alvarez)
Member id
UHC-79179-52
Confidence
1
Method
probabilistic
MBR-000921CLM-423790
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007678
Orphan claim re-pointed
Claims processor
CLM-426817 → UHC-17778-93 (Stephanie Ward)
Member id
UHC-17778-93
Confidence
1
Method
probabilistic
MBR-008000CLM-426817
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007679
Orphan claim re-pointed
Claims processor
CLM-417070 → UHC-73875-97 (Sara Wagner)
Member id
UHC-73875-97
Confidence
0.93
Method
probabilistic
MBR-021052CLM-417070
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007680
Orphan claim re-pointed
Claims processor
CLM-411490 → UHC-99380-89 (Lucia Bailey)
Member id
UHC-99380-89
Confidence
1
Method
probabilistic
MBR-010360CLM-411490
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007681
Orphan claim re-pointed
Claims processor
CLM-425432 → UHC-14829-62 (Larry Mendoza)
Member id
UHC-14829-62
Confidence
0.99
Method
probabilistic
MBR-004711CLM-425432
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007682
Orphan claim re-pointed
Claims processor
CLM-429166 → UHC-70952-79 (Nathan Peters)
Member id
UHC-70952-79
Confidence
1
Method
probabilistic
MBR-003072CLM-429166
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007683
Orphan claim re-pointed
Claims processor
CLM-403913 → UHC-93972-21 (Jessiac Carter)
Member id
UHC-93972-21
Confidence
0.97
Method
probabilistic
MBR-003501CLM-403913
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007684
Orphan claim re-pointed
Claims processor
CLM-429707 → UHC-18032-11 (Stephen Harris)
Member id
UHC-18032-11
Confidence
0.97
Method
deterministic
MBR-013380CLM-429707
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007685
Orphan claim re-pointed
Claims processor
CLM-422315 → UHC-46337-12 (Lisa Ferguson)
Member id
UHC-46337-12
Confidence
1
Method
probabilistic
MBR-022429CLM-422315
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007686
Orphan claim re-pointed
Claims processor
CLM-431720 → UHC-22895-17 (Maria Armstrong)
Member id
UHC-22895-17
Confidence
1
Method
probabilistic
MBR-007493CLM-431720
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007687
Orphan claim re-pointed
Claims processor
CLM-415206 → UHC-86415-53 (Betty Romero)
Member id
UHC-86415-53
Confidence
1
Method
probabilistic
MBR-019486CLM-415206
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007688
Orphan claim re-pointed
Claims processor
CLM-414912 → UHC-89766-39 (Dennis Hamilton)
Member id
UHC-89766-39
Confidence
1
Method
probabilistic
MBR-014027CLM-414912
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007689
Orphan claim re-pointed
Claims processor
CLM-425110 → UHC-46808-74 (Teresa Rivera)
Member id
UHC-46808-74
Confidence
1
Method
probabilistic
MBR-022872CLM-425110
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 127 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.