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-007740
Orphan claim re-pointed
Claims processor
CLM-407031 → UHC-53622-56 (Olivia Guzman)
Member id
UHC-53622-56
Confidence
1
Method
probabilistic
MBR-010740CLM-407031
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007741
Orphan claim re-pointed
Claims processor
CLM-418687 → UHC-41801-41 (Samuel Oliver)
Member id
UHC-41801-41
Confidence
1
Method
probabilistic
MBR-022973CLM-418687
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007742
Orphan claim re-pointed
Claims processor
CLM-406934 → UHC-49832-15 (Lisa Howard)
Member id
UHC-49832-15
Confidence
1
Method
probabilistic
MBR-009979CLM-406934
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007743
Orphan claim re-pointed
Claims processor
CLM-418289 → UHC-39736-97 (Christine Silva)
Member id
UHC-39736-97
Confidence
1
Method
probabilistic
MBR-031692CLM-418289
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007744
Orphan claim re-pointed
Claims processor
CLM-422267 → UHC-77345-52 (Christina Willis)
Member id
UHC-77345-52
Confidence
1
Method
probabilistic
MBR-012962CLM-422267
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007745
Orphan claim re-pointed
Claims processor
CLM-418922 → UHC-95565-83 (Mary Miller)
Member id
UHC-95565-83
Confidence
1
Method
probabilistic
MBR-002362CLM-418922
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007746
Orphan claim re-pointed
Claims processor
CLM-400077 → UHC-30103-89 (Helen Reed)
Member id
UHC-30103-89
Confidence
1
Method
probabilistic
MBR-030995CLM-400077
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007747
Orphan claim re-pointed
Claims processor
CLM-428389 → UHC-22171-96 (Frank Fernandez)
Member id
UHC-22171-96
Confidence
1
Method
probabilistic
MBR-010836CLM-428389
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007748
Orphan claim re-pointed
Claims processor
CLM-417562 → UHC-29409-54 (Bobby Harris)
Member id
UHC-29409-54
Confidence
1
Method
probabilistic
MBR-022516CLM-417562
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007749
Orphan claim re-pointed
Claims processor
CLM-408508 → UHC-84176-83 (Brenda Obrien)
Member id
UHC-84176-83
Confidence
1
Method
probabilistic
MBR-033192CLM-408508
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007750
Orphan claim re-pointed
Claims processor
CLM-406139 → UHC-20478-93 (Jacob Kim)
Member id
UHC-20478-93
Confidence
0.97
Method
deterministic
MBR-033220CLM-406139
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007751
Orphan claim re-pointed
Claims processor
CLM-427222 → UHC-68801-10 (Teresa Sims)
Member id
UHC-68801-10
Confidence
1
Method
probabilistic
MBR-007145CLM-427222
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007752
Orphan claim re-pointed
Claims processor
CLM-413776 → UHC-19036-31 (Frank Walsh)
Member id
UHC-19036-31
Confidence
1
Method
probabilistic
MBR-011936CLM-413776
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007753
Orphan claim re-pointed
Claims processor
CLM-432767 → UHC-45303-32 (Doris Meyer)
Member id
UHC-45303-32
Confidence
1
Method
probabilistic
MBR-023407CLM-432767
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007754
Orphan claim re-pointed
Claims processor
CLM-415169 → UHC-57734-49 (Isabella Robertson)
Member id
UHC-57734-49
Confidence
1
Method
probabilistic
MBR-012411CLM-415169
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007755
Orphan claim re-pointed
Claims processor
CLM-417343 → UHC-57685-41 (Kimberly Austin)
Member id
UHC-57685-41
Confidence
0.94
Method
probabilistic
MBR-042907CLM-417343
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007756
Orphan claim re-pointed
Claims processor
CLM-419922 → UHC-47161-46 (Rlph Fernandez)
Member id
UHC-47161-46
Confidence
0.97
Method
deterministic
MBR-043296CLM-419922
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007757
Orphan claim re-pointed
Claims processor
CLM-422031 → UHC-88438-07 (Julie Flores)
Member id
UHC-88438-07
Confidence
0.93
Method
probabilistic
MBR-009086CLM-422031
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007758
Orphan claim re-pointed
Claims processor
CLM-421102 → UHC-83726-54 (Jeremy Garcia)
Member id
UHC-83726-54
Confidence
1
Method
probabilistic
MBR-002997CLM-421102
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007759
Orphan claim re-pointed
Claims processor
CLM-415917 → UHC-84155-80 (Karen Montgomery)
Member id
UHC-84155-80
Confidence
1
Method
probabilistic
MBR-008254CLM-415917
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007760
Orphan claim re-pointed
Claims processor
CLM-429630 → UHC-25427-90 (Amber Banks)
Member id
UHC-25427-90
Confidence
1
Method
probabilistic
MBR-002034CLM-429630
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007761
Orphan claim re-pointed
Claims processor
CLM-429949 → UHC-28727-85 (Frances Hansen)
Member id
UHC-28727-85
Confidence
1
Method
probabilistic
MBR-024524CLM-429949
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007762
Orphan claim re-pointed
Claims processor
CLM-404927 → UHC-99163-01 (Vincent Hart)
Member id
UHC-99163-01
Confidence
0.94
Method
probabilistic
MBR-031356CLM-404927
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007763
Orphan claim re-pointed
Claims processor
CLM-415650 → UHC-45989-53 (Charles Fowler)
Member id
UHC-45989-53
Confidence
1
Method
probabilistic
MBR-026198CLM-415650
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007764
Orphan claim re-pointed
Claims processor
CLM-412571 → UHC-54449-78 (Noah Sims)
Member id
UHC-54449-78
Confidence
1
Method
probabilistic
MBR-018776CLM-412571
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007765
Orphan claim re-pointed
Claims processor
CLM-429855 → UHC-22640-29 (Amanda Phillips)
Member id
UHC-22640-29
Confidence
1
Method
probabilistic
MBR-006865CLM-429855
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007766
Orphan claim re-pointed
Claims processor
CLM-429628 → UHC-50638-68 (Christopher Brown)
Member id
UHC-50638-68
Confidence
1
Method
probabilistic
MBR-032394CLM-429628
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007767
Orphan claim re-pointed
Claims processor
CLM-416314 → UHC-16929-82 (Lucia Fuller)
Member id
UHC-16929-82
Confidence
1
Method
probabilistic
MBR-005729CLM-416314
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007768
Orphan claim re-pointed
Claims processor
CLM-402088 → UHC-04491-04 (Omar Holmes)
Member id
UHC-04491-04
Confidence
1
Method
probabilistic
MBR-039456CLM-402088
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007769
Orphan claim re-pointed
Claims processor
CLM-426707 → UHC-49414-59 (Gregory Palmer)
Member id
UHC-49414-59
Confidence
1
Method
probabilistic
MBR-003660CLM-426707
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007770
Orphan claim re-pointed
Claims processor
CLM-419898 → UHC-83000-99 (Amy Castillo)
Member id
UHC-83000-99
Confidence
0.97
Method
deterministic
MBR-009038CLM-419898
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007771
Orphan claim re-pointed
Claims processor
CLM-404814 → UHC-50386-34 (Bobby Rivera)
Member id
UHC-50386-34
Confidence
1
Method
probabilistic
MBR-037350CLM-404814
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007772
Orphan claim re-pointed
Claims processor
CLM-402681 → UHC-46973-89 (Kenneth Perkins)
Member id
UHC-46973-89
Confidence
1
Method
probabilistic
MBR-003454CLM-402681
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007773
Orphan claim re-pointed
Claims processor
CLM-414989 → UHC-96876-11 (Lori Elliott)
Member id
UHC-96876-11
Confidence
1
Method
probabilistic
MBR-017189CLM-414989
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007774
Orphan claim re-pointed
Claims processor
CLM-406571 → UHC-69881-24 (Jean Ward)
Member id
UHC-69881-24
Confidence
1
Method
probabilistic
MBR-028505CLM-406571
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007775
Orphan claim re-pointed
Claims processor
CLM-413058 → UHC-07773-71 (Danielle Thompson)
Member id
UHC-07773-71
Confidence
1
Method
probabilistic
MBR-020331CLM-413058
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007776
Orphan claim re-pointed
Claims processor
CLM-430977 → UHC-59549-90 (Stephanie Berry)
Member id
UHC-59549-90
Confidence
1.00
Method
probabilistic
MBR-005716CLM-430977
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007777
Orphan claim re-pointed
Claims processor
CLM-426626 → UHC-06372-33 (Jennifer Cox)
Member id
UHC-06372-33
Confidence
1
Method
probabilistic
MBR-041500CLM-426626
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007778
Orphan claim re-pointed
Claims processor
CLM-419350 → UHC-54757-66 (Marilyn Ray)
Member id
UHC-54757-66
Confidence
1
Method
probabilistic
MBR-024134CLM-419350
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007779
Orphan claim re-pointed
Claims processor
CLM-408021 → UHC-21036-35 (Carlos Stone)
Member id
UHC-21036-35
Confidence
0.97
Method
deterministic
MBR-015332CLM-408021
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007780
Orphan claim re-pointed
Claims processor
CLM-403062 → UHC-07902-98 (Julie Cox)
Member id
UHC-07902-98
Confidence
0.97
Method
deterministic
MBR-032868CLM-403062
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007781
Orphan claim re-pointed
Claims processor
CLM-429812 → UHC-48838-44 (Elizabeth Ryan)
Member id
UHC-48838-44
Confidence
1.00
Method
probabilistic
MBR-009074CLM-429812
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007782
Orphan claim re-pointed
Claims processor
CLM-424098 → UHC-56905-68 (Russell Barnes)
Member id
UHC-56905-68
Confidence
0.99
Method
probabilistic
MBR-001390CLM-424098
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007783
Orphan claim re-pointed
Claims processor
CLM-400288 → UHC-84952-58 (Ryan Howard)
Member id
UHC-84952-58
Confidence
0.93
Method
probabilistic
MBR-004021CLM-400288
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007784
Orphan claim re-pointed
Claims processor
CLM-418399 → UHC-90566-12 (Christian Singh)
Member id
UHC-90566-12
Confidence
1
Method
probabilistic
MBR-018156CLM-418399
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007785
Orphan claim re-pointed
Claims processor
CLM-409916 → UHC-41645-14 (Kathleen Williamson)
Member id
UHC-41645-14
Confidence
0.97
Method
deterministic
MBR-016815CLM-409916
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007786
Orphan claim re-pointed
Claims processor
CLM-424578 → UHC-37864-18 (Austin Bell)
Member id
UHC-37864-18
Confidence
1
Method
probabilistic
MBR-007302CLM-424578
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007787
Orphan claim re-pointed
Claims processor
CLM-413081 → UHC-71280-23 (Joyce Fisher)
Member id
UHC-71280-23
Confidence
0.97
Method
deterministic
MBR-016051CLM-413081
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007788
Orphan claim re-pointed
Claims processor
CLM-403974 → UHC-20168-56 (Hannah Nguyen)
Member id
UHC-20168-56
Confidence
1
Method
probabilistic
MBR-020470CLM-403974
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007789
Orphan claim re-pointed
Claims processor
CLM-427648 → UHC-87953-54 (Margaret Jensen)
Member id
UHC-87953-54
Confidence
1
Method
probabilistic
MBR-009721CLM-427648
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 129 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.