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-008340
Orphan claim re-pointed
Claims processor
CLM-406465 → UHC-73695-03 (Kathleen Moore)
Member id
UHC-73695-03
Confidence
1
Method
probabilistic
MBR-039191CLM-406465
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008341
Orphan claim re-pointed
Claims processor
CLM-423198 → UHC-37719-32 (Ralph Lynch)
Member id
UHC-37719-32
Confidence
1
Method
probabilistic
MBR-033164CLM-423198
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008342
Orphan claim re-pointed
Claims processor
CLM-422746 → UHC-73785-46 (Elizabeth Reyes)
Member id
UHC-73785-46
Confidence
1
Method
probabilistic
MBR-015705CLM-422746
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008343
Orphan claim re-pointed
Claims processor
CLM-430722 → UHC-97229-55 (Diego Weaver)
Member id
UHC-97229-55
Confidence
1
Method
probabilistic
MBR-033646CLM-430722
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008344
Orphan claim re-pointed
Claims processor
CLM-418815 → UHC-89046-92 (Richard Boyd)
Member id
UHC-89046-92
Confidence
1
Method
probabilistic
MBR-002158CLM-418815
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008345
Orphan claim re-pointed
Claims processor
CLM-422822 → UHC-32163-31 (Terry Olson)
Member id
UHC-32163-31
Confidence
0.97
Method
deterministic
MBR-038806CLM-422822
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008346
Orphan claim re-pointed
Claims processor
CLM-416320 → UHC-50247-35 (Gabriel Carr)
Member id
UHC-50247-35
Confidence
1
Method
probabilistic
MBR-019208CLM-416320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008347
Orphan claim re-pointed
Claims processor
CLM-413438 → UHC-35719-69 (Alan Sanchez)
Member id
UHC-35719-69
Confidence
0.97
Method
deterministic
MBR-008705CLM-413438
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008348
Orphan claim re-pointed
Claims processor
CLM-416841 → UHC-62023-38 (Kimberly Henry)
Member id
UHC-62023-38
Confidence
0.97
Method
deterministic
MBR-005275CLM-416841
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008349
Orphan claim re-pointed
Claims processor
CLM-421894 → UHC-62313-89 (Ethan Jackson)
Member id
UHC-62313-89
Confidence
1
Method
probabilistic
MBR-000104CLM-421894
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008350
Orphan claim re-pointed
Claims processor
CLM-400494 → UHC-26457-27 (Amanda Marshall)
Member id
UHC-26457-27
Confidence
0.99
Method
probabilistic
MBR-020501CLM-400494
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008351
Orphan claim re-pointed
Claims processor
CLM-428790 → UHC-26758-34 (Christina Gonzalez)
Member id
UHC-26758-34
Confidence
1
Method
probabilistic
MBR-026475CLM-428790
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008352
Orphan claim re-pointed
Claims processor
CLM-405255 → UHC-12260-84 (Alexis Washington)
Member id
UHC-12260-84
Confidence
0.94
Method
probabilistic
MBR-037635CLM-405255
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008353
Orphan claim re-pointed
Claims processor
CLM-408535 → UHC-70356-45 (Kathy Matthews)
Member id
UHC-70356-45
Confidence
1
Method
probabilistic
MBR-032610CLM-408535
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008354
Orphan claim re-pointed
Claims processor
CLM-418117 → UHC-49734-04 (Steven Henry)
Member id
UHC-49734-04
Confidence
1
Method
probabilistic
MBR-030346CLM-418117
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008355
Orphan claim re-pointed
Claims processor
CLM-430033 → UHC-85512-04 (Keith Rogers)
Member id
UHC-85512-04
Confidence
1
Method
probabilistic
MBR-007435CLM-430033
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008356
Orphan claim re-pointed
Claims processor
CLM-419293 → UHC-49759-88 (Grace Henry)
Member id
UHC-49759-88
Confidence
0.94
Method
probabilistic
MBR-010149CLM-419293
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008357
Orphan claim re-pointed
Claims processor
CLM-406602 → UHC-82645-48 (Douglas Garza)
Member id
UHC-82645-48
Confidence
1
Method
probabilistic
MBR-002425CLM-406602
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008358
Orphan claim re-pointed
Claims processor
CLM-407251 → UHC-73584-46 (Diana Cooper)
Member id
UHC-73584-46
Confidence
1
Method
probabilistic
MBR-013232CLM-407251
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008359
Orphan claim re-pointed
Claims processor
CLM-408200 → UHC-55258-87 (Theresa Torres)
Member id
UHC-55258-87
Confidence
0.97
Method
deterministic
MBR-002788CLM-408200
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008360
Orphan claim re-pointed
Claims processor
CLM-412784 → UHC-81624-09 (Christina Herrera)
Member id
UHC-81624-09
Confidence
1
Method
probabilistic
MBR-023695CLM-412784
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008361
Orphan claim re-pointed
Claims processor
CLM-400917 → UHC-48607-37 (Carl Cruz)
Member id
UHC-48607-37
Confidence
1
Method
probabilistic
MBR-027313CLM-400917
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008362
Orphan claim re-pointed
Claims processor
CLM-411168 → UHC-74741-25 (Jose Morrison)
Member id
UHC-74741-25
Confidence
1
Method
probabilistic
MBR-008883CLM-411168
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008363
Orphan claim re-pointed
Claims processor
CLM-418558 → UHC-12369-48 (Lauren Graham)
Member id
UHC-12369-48
Confidence
0.99
Method
probabilistic
MBR-023222CLM-418558
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008364
Orphan claim re-pointed
Claims processor
CLM-418603 → UHC-12777-98 (Cynthia Gray)
Member id
UHC-12777-98
Confidence
1
Method
probabilistic
MBR-011635CLM-418603
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008365
Orphan claim re-pointed
Claims processor
CLM-412411 → UHC-85895-32 (Andrew Foster)
Member id
UHC-85895-32
Confidence
0.98
Method
probabilistic
MBR-010862CLM-412411
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008366
Orphan claim re-pointed
Claims processor
CLM-412926 → UHC-81455-82 (Sharon Cooper)
Member id
UHC-81455-82
Confidence
0.98
Method
probabilistic
MBR-007657CLM-412926
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008367
Orphan claim re-pointed
Claims processor
CLM-405055 → UHC-82910-48 (Ricard Bailey)
Member id
UHC-82910-48
Confidence
0.99
Method
probabilistic
MBR-016067CLM-405055
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008368
Orphan claim re-pointed
Claims processor
CLM-429114 → UHC-50353-26 (Santiago Stone)
Member id
UHC-50353-26
Confidence
1
Method
probabilistic
MBR-006505CLM-429114
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008369
Orphan claim re-pointed
Claims processor
CLM-413958 → UHC-20227-17 (Diana Hamilton)
Member id
UHC-20227-17
Confidence
1
Method
probabilistic
MBR-002135CLM-413958
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008370
Orphan claim re-pointed
Claims processor
CLM-415488 → UHC-48738-18 (Rebecca Hart)
Member id
UHC-48738-18
Confidence
1
Method
probabilistic
MBR-018635CLM-415488
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008371
Orphan claim re-pointed
Claims processor
CLM-419590 → UHC-93478-47 (Nathan Robertson)
Member id
UHC-93478-47
Confidence
1
Method
probabilistic
MBR-013711CLM-419590
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008372
Orphan claim re-pointed
Claims processor
CLM-426452 → UHC-13952-43 (Margaret Weaver)
Member id
UHC-13952-43
Confidence
1
Method
probabilistic
MBR-000298CLM-426452
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008373
Orphan claim re-pointed
Claims processor
CLM-428948 → UHC-39871-55 (Vincent Castillo)
Member id
UHC-39871-55
Confidence
1
Method
probabilistic
MBR-021927CLM-428948
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008374
Orphan claim re-pointed
Claims processor
CLM-413239 → UHC-56193-25 (Joseph Moore)
Member id
UHC-56193-25
Confidence
0.97
Method
deterministic
MBR-038386CLM-413239
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008375
Orphan claim re-pointed
Claims processor
CLM-430639 → UHC-26050-17 (Beverly Davis)
Member id
UHC-26050-17
Confidence
1
Method
probabilistic
MBR-007037CLM-430639
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008376
Orphan claim re-pointed
Claims processor
CLM-409526 → UHC-43618-30 (Elizabeth Greene)
Member id
UHC-43618-30
Confidence
0.99
Method
probabilistic
MBR-008656CLM-409526
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008377
Orphan claim re-pointed
Claims processor
CLM-403487 → UHC-51240-43 (Camila Olson)
Member id
UHC-51240-43
Confidence
1
Method
probabilistic
MBR-006706CLM-403487
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008378
Orphan claim re-pointed
Claims processor
CLM-411093 → UHC-82957-73 (Luis Garcia)
Member id
UHC-82957-73
Confidence
0.99
Method
probabilistic
MBR-012889CLM-411093
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008379
Orphan claim re-pointed
Claims processor
CLM-429699 → UHC-51125-18 (Douglas Banks)
Member id
UHC-51125-18
Confidence
0.93
Method
probabilistic
MBR-008629CLM-429699
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008380
Orphan claim re-pointed
Claims processor
CLM-428758 → UHC-13138-62 (Gabriel Sanders)
Member id
UHC-13138-62
Confidence
1.00
Method
probabilistic
MBR-013214CLM-428758
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008381
Orphan claim re-pointed
Claims processor
CLM-400869 → UHC-88462-16 (Frances Bennett)
Member id
UHC-88462-16
Confidence
0.97
Method
deterministic
MBR-006188CLM-400869
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008382
Orphan claim re-pointed
Claims processor
CLM-403269 → UHC-32602-43 (Joe Hunter)
Member id
UHC-32602-43
Confidence
1
Method
probabilistic
MBR-035611CLM-403269
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008383
Orphan claim re-pointed
Claims processor
CLM-410116 → UHC-23636-43 (Cheryl Vazquez)
Member id
UHC-23636-43
Confidence
1
Method
probabilistic
MBR-018548CLM-410116
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008384
Orphan claim re-pointed
Claims processor
CLM-425339 → UHC-09489-36 (George Bishop)
Member id
UHC-09489-36
Confidence
1
Method
probabilistic
MBR-004671CLM-425339
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008385
Orphan claim re-pointed
Claims processor
CLM-428274 → UHC-56282-29 (Pamela Edwards)
Member id
UHC-56282-29
Confidence
0.97
Method
deterministic
MBR-016032CLM-428274
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008386
Orphan claim re-pointed
Claims processor
CLM-431591 → UHC-19660-26 (Ethan Kim)
Member id
UHC-19660-26
Confidence
1
Method
probabilistic
MBR-007993CLM-431591
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008387
Orphan claim re-pointed
Claims processor
CLM-416704 → UHC-09067-17 (Maria Robinson)
Member id
UHC-09067-17
Confidence
0.97
Method
deterministic
MBR-038924CLM-416704
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008388
Orphan claim re-pointed
Claims processor
CLM-431336 → UHC-56910-92 (Brian Fox)
Member id
UHC-56910-92
Confidence
1
Method
probabilistic
MBR-001264CLM-431336
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008389
Orphan claim re-pointed
Claims processor
CLM-402879 → UHC-33407-72 (Dylan Taylor)
Member id
UHC-33407-72
Confidence
0.97
Method
deterministic
MBR-042563CLM-402879
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 141 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.