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-008090
Orphan claim re-pointed
Claims processor
CLM-431472 → UHC-12167-44 (Carolyn Jordan)
Member id
UHC-12167-44
Confidence
0.97
Method
deterministic
MBR-037700CLM-431472
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008091
Orphan claim re-pointed
Claims processor
CLM-401820 → UHC-64480-79 (Jonathan Rivera)
Member id
UHC-64480-79
Confidence
1
Method
probabilistic
MBR-002406CLM-401820
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008092
Orphan claim re-pointed
Claims processor
CLM-423731 → UHC-61347-45 (Teresa Burton)
Member id
UHC-61347-45
Confidence
1
Method
probabilistic
MBR-024048CLM-423731
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008093
Orphan claim re-pointed
Claims processor
CLM-432173 → UHC-52800-45 (Alice Hart)
Member id
UHC-52800-45
Confidence
1
Method
probabilistic
MBR-041383CLM-432173
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008094
Orphan claim re-pointed
Claims processor
CLM-419127 → UHC-70586-14 (Ethan Wood)
Member id
UHC-70586-14
Confidence
0.99
Method
probabilistic
MBR-040320CLM-419127
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008095
Orphan claim re-pointed
Claims processor
CLM-409528 → UHC-50046-10 (Matthew Hanson)
Member id
UHC-50046-10
Confidence
1
Method
probabilistic
MBR-007945CLM-409528
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008096
Orphan claim re-pointed
Claims processor
CLM-404515 → UHC-29058-69 (Deborah Munoz)
Member id
UHC-29058-69
Confidence
1
Method
probabilistic
MBR-033412CLM-404515
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008097
Orphan claim re-pointed
Claims processor
CLM-413643 → UHC-71517-82 (Lauren Hill)
Member id
UHC-71517-82
Confidence
1
Method
probabilistic
MBR-006426CLM-413643
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008098
Orphan claim re-pointed
Claims processor
CLM-418228 → UHC-34231-80 (Omar Rivera)
Member id
UHC-34231-80
Confidence
0.86
Method
probabilistic
MBR-042743CLM-418228
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008099
Orphan claim re-pointed
Claims processor
CLM-400324 → UHC-47701-51 (Edward Howell)
Member id
UHC-47701-51
Confidence
0.97
Method
deterministic
MBR-010029CLM-400324
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008100
Orphan claim re-pointed
Claims processor
CLM-408976 → UHC-27676-63 (Nicole Sullivan)
Member id
UHC-27676-63
Confidence
0.97
Method
deterministic
MBR-029876CLM-408976
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008101
Orphan claim re-pointed
Claims processor
CLM-428496 → UHC-27495-29 (Priya Shaw)
Member id
UHC-27495-29
Confidence
1
Method
probabilistic
MBR-011434CLM-428496
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008102
Orphan claim re-pointed
Claims processor
CLM-423029 → UHC-34532-34 (Ruth Parker)
Member id
UHC-34532-34
Confidence
1
Method
probabilistic
MBR-030650CLM-423029
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008103
Orphan claim re-pointed
Claims processor
CLM-404633 → UHC-19228-66 (Deborah Day)
Member id
UHC-19228-66
Confidence
1
Method
probabilistic
MBR-007095CLM-404633
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008104
Orphan claim re-pointed
Claims processor
CLM-416461 → UHC-16686-90 (Jonathan Mason)
Member id
UHC-16686-90
Confidence
1
Method
probabilistic
MBR-006335CLM-416461
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008105
Orphan claim re-pointed
Claims processor
CLM-419286 → UHC-03266-71 (Amber Munoz)
Member id
UHC-03266-71
Confidence
1
Method
probabilistic
MBR-011086CLM-419286
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008106
Orphan claim re-pointed
Claims processor
CLM-419139 → UHC-31227-73 (Keith Berry)
Member id
UHC-31227-73
Confidence
1
Method
probabilistic
MBR-020622CLM-419139
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008107
Orphan claim re-pointed
Claims processor
CLM-407086 → UHC-44422-88 (Ralph Daniels)
Member id
UHC-44422-88
Confidence
1
Method
probabilistic
MBR-000036CLM-407086
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008108
Orphan claim re-pointed
Claims processor
CLM-408255 → UHC-95675-57 (Kayla Chen)
Member id
UHC-95675-57
Confidence
1
Method
probabilistic
MBR-001335CLM-408255
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008109
Orphan claim re-pointed
Claims processor
CLM-404185 → UHC-37788-27 (Melissa Tran)
Member id
UHC-37788-27
Confidence
1
Method
probabilistic
MBR-000200CLM-404185
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008110
Orphan claim re-pointed
Claims processor
CLM-428378 → UHC-91491-21 (Cheryl Bradley)
Member id
UHC-91491-21
Confidence
0.93
Method
probabilistic
MBR-012550CLM-428378
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008111
Orphan claim re-pointed
Claims processor
CLM-402793 → UHC-16351-42 (Daniel Rios)
Member id
UHC-16351-42
Confidence
1
Method
probabilistic
MBR-039306CLM-402793
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008112
Orphan claim re-pointed
Claims processor
CLM-417360 → UHC-20211-16 (Diane Kim)
Member id
UHC-20211-16
Confidence
1
Method
probabilistic
MBR-002815CLM-417360
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008113
Orphan claim re-pointed
Claims processor
CLM-405192 → UHC-46402-70 (Benjamin Hunt)
Member id
UHC-46402-70
Confidence
1
Method
probabilistic
MBR-021931CLM-405192
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008114
Orphan claim re-pointed
Claims processor
CLM-404535 → UHC-06069-32 (Sofia Lynch)
Member id
UHC-06069-32
Confidence
1
Method
probabilistic
MBR-016391CLM-404535
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008115
Orphan claim re-pointed
Claims processor
CLM-426764 → UHC-82369-83 (Katherine Bryant)
Member id
UHC-82369-83
Confidence
1
Method
probabilistic
MBR-035448CLM-426764
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008116
Orphan claim re-pointed
Claims processor
CLM-405003 → UHC-93428-71 (Carl Rihards)
Member id
UHC-93428-71
Confidence
0.99
Method
probabilistic
MBR-005038CLM-405003
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008117
Orphan claim re-pointed
Claims processor
CLM-410338 → UHC-62319-26 (Evelyn McDonald)
Member id
UHC-62319-26
Confidence
1
Method
probabilistic
MBR-015345CLM-410338
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008118
Orphan claim re-pointed
Claims processor
CLM-431092 → UHC-97823-17 (Beverly Brown)
Member id
UHC-97823-17
Confidence
1
Method
probabilistic
MBR-030738CLM-431092
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008119
Orphan claim re-pointed
Claims processor
CLM-409382 → UHC-22854-38 (Anna Carlson)
Member id
UHC-22854-38
Confidence
1
Method
probabilistic
MBR-005477CLM-409382
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008120
Orphan claim re-pointed
Claims processor
CLM-402318 → UHC-64640-18 (Laura Alvarado)
Member id
UHC-64640-18
Confidence
0.97
Method
deterministic
MBR-025866CLM-402318
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008121
Orphan claim re-pointed
Claims processor
CLM-402689 → UHC-46381-97 (Madison Jones)
Member id
UHC-46381-97
Confidence
0.99
Method
probabilistic
MBR-032128CLM-402689
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008122
Orphan claim re-pointed
Claims processor
CLM-403017 → UHC-61543-39 (Nancy Vazquez)
Member id
UHC-61543-39
Confidence
0.99
Method
probabilistic
MBR-008493CLM-403017
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008123
Orphan claim re-pointed
Claims processor
CLM-408638 → UHC-82440-56 (Lori Dominguez)
Member id
UHC-82440-56
Confidence
0.97
Method
deterministic
MBR-036622CLM-408638
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008124
Orphan claim re-pointed
Claims processor
CLM-403516 → UHC-32690-49 (Becky West)
Member id
UHC-32690-49
Confidence
1
Method
probabilistic
MBR-034708CLM-403516
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008125
Orphan claim re-pointed
Claims processor
CLM-426818 → UHC-17778-93 (Stephanie Ward)
Member id
UHC-17778-93
Confidence
0.98
Method
probabilistic
MBR-008000CLM-426818
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008126
Orphan claim re-pointed
Claims processor
CLM-412172 → UHC-97895-36 (Barbara Gilbert)
Member id
UHC-97895-36
Confidence
0.97
Method
deterministic
MBR-042429CLM-412172
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008127
Orphan claim re-pointed
Claims processor
CLM-402178 → UHC-92206-60 (Arthur Reynolds)
Member id
UHC-92206-60
Confidence
1
Method
probabilistic
MBR-013279CLM-402178
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008128
Orphan claim re-pointed
Claims processor
CLM-432374 → UHC-12963-51 (Debra Aguilar)
Member id
UHC-12963-51
Confidence
0.97
Method
deterministic
MBR-012389CLM-432374
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008129
Orphan claim re-pointed
Claims processor
CLM-426165 → UHC-46118-23 (Natalie Alvarado)
Member id
UHC-46118-23
Confidence
1
Method
probabilistic
MBR-035791CLM-426165
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008130
Orphan claim re-pointed
Claims processor
CLM-426584 → UHC-69270-12 (Stephen Alvarado)
Member id
UHC-69270-12
Confidence
1
Method
probabilistic
MBR-001966CLM-426584
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008131
Orphan claim re-pointed
Claims processor
CLM-429552 → UHC-53608-54 (Anna Harvey)
Member id
UHC-53608-54
Confidence
1
Method
probabilistic
MBR-019852CLM-429552
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008132
Orphan claim re-pointed
Claims processor
CLM-404161 → UHC-75872-76 (Peter Li)
Member id
UHC-75872-76
Confidence
1
Method
probabilistic
MBR-001422CLM-404161
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008133
Orphan claim re-pointed
Claims processor
CLM-418083 → UHC-77350-19 (Laura Banks)
Member id
UHC-77350-19
Confidence
0.97
Method
deterministic
MBR-035949CLM-418083
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008134
Orphan claim re-pointed
Claims processor
CLM-427825 → UHC-64152-85 (Donna Ramos)
Member id
UHC-64152-85
Confidence
1
Method
probabilistic
MBR-027937CLM-427825
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008135
Orphan claim re-pointed
Claims processor
CLM-404653 → UHC-77455-70 (Hannah Wood)
Member id
UHC-77455-70
Confidence
1
Method
probabilistic
MBR-001591CLM-404653
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008136
Orphan claim re-pointed
Claims processor
CLM-404710 → UHC-28560-68 (Charles Rice)
Member id
UHC-28560-68
Confidence
1
Method
probabilistic
MBR-006164CLM-404710
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008137
Orphan claim re-pointed
Claims processor
CLM-411091 → UHC-97681-70 (Mari Hernandez)
Member id
UHC-97681-70
Confidence
0.99
Method
probabilistic
MBR-037737CLM-411091
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008138
Orphan claim re-pointed
Claims processor
CLM-429536 → UHC-91248-73 (Arthur Vasquez)
Member id
UHC-91248-73
Confidence
0.99
Method
probabilistic
MBR-003730CLM-429536
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008139
Orphan claim re-pointed
Claims processor
CLM-411488 → UHC-31330-62 (Joe Adams)
Member id
UHC-31330-62
Confidence
1
Method
probabilistic
MBR-022403CLM-411488
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 136 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.