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-007990
Orphan claim re-pointed
Claims processor
CLM-404648 → UHC-13806-99 (Mary Wilson)
Member id
UHC-13806-99
Confidence
1
Method
probabilistic
MBR-029755CLM-404648
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007991
Orphan claim re-pointed
Claims processor
CLM-408299 → UHC-70584-52 (Lisa Morris)
Member id
UHC-70584-52
Confidence
0.97
Method
deterministic
MBR-024783CLM-408299
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007992
Orphan claim re-pointed
Claims processor
CLM-409492 → UHC-14810-76 (Nathan Cunningham)
Member id
UHC-14810-76
Confidence
1
Method
probabilistic
MBR-000595CLM-409492
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007993
Orphan claim re-pointed
Claims processor
CLM-410309 → UHC-57906-75 (Wei Berry)
Member id
UHC-57906-75
Confidence
1
Method
probabilistic
MBR-023706CLM-410309
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007994
Orphan claim re-pointed
Claims processor
CLM-401235 → UHC-19454-66 (Amanda Sullivan)
Member id
UHC-19454-66
Confidence
1
Method
probabilistic
MBR-037391CLM-401235
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007995
Orphan claim re-pointed
Claims processor
CLM-402907 → UHC-56867-96 (Peter Brooks)
Member id
UHC-56867-96
Confidence
1
Method
probabilistic
MBR-023790CLM-402907
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007996
Orphan claim re-pointed
Claims processor
CLM-409116 → UHC-60845-71 (Eugene Edwards)
Member id
UHC-60845-71
Confidence
1
Method
probabilistic
MBR-042518CLM-409116
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007997
Orphan claim re-pointed
Claims processor
CLM-420618 → UHC-26240-33 (Nathan Tran)
Member id
UHC-26240-33
Confidence
1
Method
probabilistic
MBR-013724CLM-420618
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007998
Orphan claim re-pointed
Claims processor
CLM-413124 → UHC-33748-51 (Frank Howard)
Member id
UHC-33748-51
Confidence
1
Method
probabilistic
MBR-019927CLM-413124
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007999
Orphan claim re-pointed
Claims processor
CLM-425155 → UHC-64681-45 (Brittany Rose)
Member id
UHC-64681-45
Confidence
0.98
Method
probabilistic
MBR-008310CLM-425155
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008000
Orphan claim re-pointed
Claims processor
CLM-418899 → UHC-92693-54 (Joseph Schultz)
Member id
UHC-92693-54
Confidence
0.97
Method
deterministic
MBR-010572CLM-418899
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008001
Orphan claim re-pointed
Claims processor
CLM-417079 → UHC-45620-36 (Ruth Price)
Member id
UHC-45620-36
Confidence
1
Method
probabilistic
MBR-000955CLM-417079
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008002
Orphan claim re-pointed
Claims processor
CLM-403408 → UHC-91099-88 (Virginia Nelson)
Member id
UHC-91099-88
Confidence
1
Method
probabilistic
MBR-007752CLM-403408
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008003
Orphan claim re-pointed
Claims processor
CLM-406886 → UHC-37564-73 (Donald Tucker)
Member id
UHC-37564-73
Confidence
1
Method
probabilistic
MBR-038309CLM-406886
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008004
Orphan claim re-pointed
Claims processor
CLM-425050 → UHC-92395-20 (Charles Ortiz)
Member id
UHC-92395-20
Confidence
1
Method
probabilistic
MBR-005373CLM-425050
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008005
Orphan claim re-pointed
Claims processor
CLM-401798 → UHC-41424-77 (Gibson Matthew)
Member id
UHC-41424-77
Confidence
1
Method
probabilistic
MBR-022334CLM-401798
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008006
Orphan claim re-pointed
Claims processor
CLM-409641 → UHC-26483-10 (Willie Hoffman)
Member id
UHC-26483-10
Confidence
1
Method
probabilistic
MBR-019671CLM-409641
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008007
Orphan claim re-pointed
Claims processor
CLM-401526 → UHC-44976-64 (Jean Bell)
Member id
UHC-44976-64
Confidence
0.97
Method
deterministic
MBR-034020CLM-401526
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008008
Orphan claim re-pointed
Claims processor
CLM-416972 → UHC-42690-59 (Jose Williamson)
Member id
UHC-42690-59
Confidence
1
Method
probabilistic
MBR-007273CLM-416972
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008009
Orphan claim re-pointed
Claims processor
CLM-406483 → UHC-92812-35 (Shirley Marshall)
Member id
UHC-92812-35
Confidence
0.97
Method
deterministic
MBR-014365CLM-406483
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008010
Orphan claim re-pointed
Claims processor
CLM-407905 → UHC-68037-68 (Adam Walsh)
Member id
UHC-68037-68
Confidence
1
Method
probabilistic
MBR-008021CLM-407905
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008011
Orphan claim re-pointed
Claims processor
CLM-415818 → UHC-57067-49 (Patricia Payne)
Member id
UHC-57067-49
Confidence
1
Method
probabilistic
MBR-005332CLM-415818
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008012
Orphan claim re-pointed
Claims processor
CLM-409244 → UHC-78323-03 (Emma Robertson)
Member id
UHC-78323-03
Confidence
1
Method
probabilistic
MBR-000467CLM-409244
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008013
Orphan claim re-pointed
Claims processor
CLM-416151 → UHC-57771-75 (Nancy Washington)
Member id
UHC-57771-75
Confidence
1
Method
probabilistic
MBR-012759CLM-416151
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008014
Orphan claim re-pointed
Claims processor
CLM-429417 → UHC-76690-56 (Douglas Lewis)
Member id
UHC-76690-56
Confidence
1
Method
probabilistic
MBR-022670CLM-429417
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008015
Orphan claim re-pointed
Claims processor
CLM-401994 → UHC-64409-56 (Alexis Henderson)
Member id
UHC-64409-56
Confidence
0.97
Method
deterministic
MBR-020588CLM-401994
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008016
Orphan claim re-pointed
Claims processor
CLM-402606 → UHC-39005-14 (Albert Myers)
Member id
UHC-39005-14
Confidence
1
Method
probabilistic
MBR-019514CLM-402606
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008017
Orphan claim re-pointed
Claims processor
CLM-409596 → UHC-86332-25 (Albert Payne)
Member id
UHC-86332-25
Confidence
1
Method
probabilistic
MBR-005955CLM-409596
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008018
Orphan claim re-pointed
Claims processor
CLM-411986 → UHC-77522-55 (Christine Elliott)
Member id
UHC-77522-55
Confidence
1
Method
probabilistic
MBR-025437CLM-411986
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008019
Orphan claim re-pointed
Claims processor
CLM-424026 → UHC-80684-62 (Susan Salazar)
Member id
UHC-80684-62
Confidence
0.97
Method
probabilistic
MBR-014263CLM-424026
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008020
Orphan claim re-pointed
Claims processor
CLM-411618 → UHC-99981-18 (Olivia Espinoza)
Member id
UHC-99981-18
Confidence
1
Method
probabilistic
MBR-012349CLM-411618
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008021
Orphan claim re-pointed
Claims processor
CLM-408268 → UHC-15361-15 (Rachel Bowman)
Member id
UHC-15361-15
Confidence
1
Method
probabilistic
MBR-019677CLM-408268
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008022
Orphan claim re-pointed
Claims processor
CLM-425335 → UHC-51560-94 (Marc Porter)
Member id
UHC-51560-94
Confidence
0.89
Method
probabilistic
MBR-042061CLM-425335
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008023
Orphan claim re-pointed
Claims processor
CLM-404848 → UHC-87366-39 (Frank Richards)
Member id
UHC-87366-39
Confidence
1
Method
probabilistic
MBR-006845CLM-404848
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008024
Orphan claim re-pointed
Claims processor
CLM-400258 → UHC-64801-14 (Daniel Wang)
Member id
UHC-64801-14
Confidence
1
Method
probabilistic
MBR-027980CLM-400258
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008025
Orphan claim re-pointed
Claims processor
CLM-416970 → UHC-76907-92 (Ana Woods)
Member id
UHC-76907-92
Confidence
1
Method
probabilistic
MBR-014805CLM-416970
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008026
Orphan claim re-pointed
Claims processor
CLM-413591 → UHC-13835-02 (Mark Arnold)
Member id
UHC-13835-02
Confidence
1
Method
probabilistic
MBR-034505CLM-413591
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008027
Orphan claim re-pointed
Claims processor
CLM-413163 → UHC-71582-77 (Janice Austin)
Member id
UHC-71582-77
Confidence
1
Method
probabilistic
MBR-023370CLM-413163
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008028
Orphan claim re-pointed
Claims processor
CLM-415209 → UHC-59243-54 (Bobby Porter)
Member id
UHC-59243-54
Confidence
1
Method
probabilistic
MBR-004838CLM-415209
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008029
Orphan claim re-pointed
Claims processor
CLM-408436 → UHC-85118-52 (Ryan Diaz)
Member id
UHC-85118-52
Confidence
1
Method
probabilistic
MBR-014971CLM-408436
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008030
Orphan claim re-pointed
Claims processor
CLM-410864 → UHC-03070-53 (Jacqueline Flores)
Member id
UHC-03070-53
Confidence
1
Method
probabilistic
MBR-027962CLM-410864
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008031
Orphan claim re-pointed
Claims processor
CLM-400924 → UHC-21483-29 (Peter Carter)
Member id
UHC-21483-29
Confidence
1
Method
probabilistic
MBR-010602CLM-400924
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008032
Orphan claim re-pointed
Claims processor
CLM-419528 → UHC-50005-94 (Billy Cook)
Member id
UHC-50005-94
Confidence
1
Method
probabilistic
MBR-009428CLM-419528
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008033
Orphan claim re-pointed
Claims processor
CLM-411782 → UHC-52569-74 (Sofia Weaver)
Member id
UHC-52569-74
Confidence
1
Method
probabilistic
MBR-025171CLM-411782
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008034
Orphan claim re-pointed
Claims processor
CLM-405737 → UHC-46437-23 (Christopher Austin)
Member id
UHC-46437-23
Confidence
1
Method
probabilistic
MBR-032436CLM-405737
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008035
Orphan claim re-pointed
Claims processor
CLM-406831 → UHC-81204-88 (Brian Gordon)
Member id
UHC-81204-88
Confidence
1
Method
probabilistic
MBR-044181CLM-406831
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008036
Orphan claim re-pointed
Claims processor
CLM-403330 → UHC-81477-97 (Teresa Hayes)
Member id
UHC-81477-97
Confidence
1
Method
probabilistic
MBR-012681CLM-403330
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008037
Orphan claim re-pointed
Claims processor
CLM-428311 → UHC-76482-85 (Matthew Nguyen)
Member id
UHC-76482-85
Confidence
0.97
Method
deterministic
MBR-005536CLM-428311
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008038
Orphan claim re-pointed
Claims processor
CLM-426250 → UHC-23257-02 (Kevin Brooks)
Member id
UHC-23257-02
Confidence
1
Method
probabilistic
MBR-009839CLM-426250
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008039
Orphan claim re-pointed
Claims processor
CLM-424479 → UHC-78069-86 (Bryan Romero)
Member id
UHC-78069-86
Confidence
0.94
Method
probabilistic
MBR-019070CLM-424479
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 134 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.