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-002040
Orphan claim re-pointed
Claims processor
CLM-410703 → UHC-65972-52 (Sarah Bowman)
Member id
UHC-65972-52
Confidence
0.97
Method
deterministic
MBR-021000CLM-410703
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002041
Orphan claim re-pointed
Claims processor
CLM-417895 → UHC-55501-27 (Mark Arnold)
Member id
UHC-55501-27
Confidence
1
Method
probabilistic
MBR-005929CLM-417895
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002042
Orphan claim re-pointed
Claims processor
CLM-400413 → UHC-45824-49 (John Gardner)
Member id
UHC-45824-49
Confidence
1
Method
probabilistic
MBR-009360CLM-400413
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002043
Orphan claim re-pointed
Claims processor
CLM-422117 → UHC-78323-14 (Lucia Stone)
Member id
UHC-78323-14
Confidence
1
Method
probabilistic
MBR-034764CLM-422117
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002044
Orphan claim re-pointed
Claims processor
CLM-421019 → UHC-71391-15 (Alice Webb)
Member id
UHC-71391-15
Confidence
1
Method
probabilistic
MBR-026362CLM-421019
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002045
Orphan claim re-pointed
Claims processor
CLM-413780 → UHC-76213-90 (Gloria Ray)
Member id
UHC-76213-90
Confidence
1
Method
probabilistic
MBR-006862CLM-413780
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002046
Orphan claim re-pointed
Claims processor
CLM-410943 → UHC-34927-03 (Valentina Ray)
Member id
UHC-34927-03
Confidence
0.97
Method
deterministic
MBR-003300CLM-410943
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002047
Orphan claim re-pointed
Claims processor
CLM-421720 → UHC-05079-55 (Mateo Silva)
Member id
UHC-05079-55
Confidence
1
Method
probabilistic
MBR-015175CLM-421720
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002048
Orphan claim re-pointed
Claims processor
CLM-402885 → UHC-65294-57 (Noah Chapman)
Member id
UHC-65294-57
Confidence
0.97
Method
deterministic
MBR-000282CLM-402885
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002049
Orphan claim re-pointed
Claims processor
CLM-408050 → UHC-09188-64 (Kathleen Carter)
Member id
UHC-09188-64
Confidence
0.97
Method
deterministic
MBR-013920CLM-408050
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002050
Orphan claim re-pointed
Claims processor
CLM-430433 → UHC-51846-88 (Joan Medina)
Member id
UHC-51846-88
Confidence
0.97
Method
deterministic
MBR-026812CLM-430433
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002051
Orphan claim re-pointed
Claims processor
CLM-416386 → UHC-74794-89 (Janice Carlson)
Member id
UHC-74794-89
Confidence
0.97
Method
deterministic
MBR-002316CLM-416386
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002052
Orphan claim re-pointed
Claims processor
CLM-407795 → UHC-52452-64 (Zachary Aguilar)
Member id
UHC-52452-64
Confidence
1
Method
probabilistic
MBR-021002CLM-407795
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002053
Orphan claim re-pointed
Claims processor
CLM-423552 → UHC-97296-45 (Doris Castillo)
Member id
UHC-97296-45
Confidence
1
Method
probabilistic
MBR-003056CLM-423552
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002054
Orphan claim re-pointed
Claims processor
CLM-416197 → UHC-35967-43 (Justin Jenkins)
Member id
UHC-35967-43
Confidence
1
Method
probabilistic
MBR-024924CLM-416197
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002055
Orphan claim re-pointed
Claims processor
CLM-412022 → UHC-15571-41 (Patricia Munoz)
Member id
UHC-15571-41
Confidence
1
Method
probabilistic
MBR-009626CLM-412022
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002056
Orphan claim re-pointed
Claims processor
CLM-401210 → UHC-70408-64 (Castro Castro)
Member id
UHC-70408-64
Confidence
1
Method
probabilistic
MBR-007307CLM-401210
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002057
Orphan claim re-pointed
Claims processor
CLM-404104 → UHC-74272-06 (Zachary Carpenter)
Member id
UHC-74272-06
Confidence
1
Method
probabilistic
MBR-000629CLM-404104
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002058
Orphan claim re-pointed
Claims processor
CLM-406432 → UHC-62397-46 (Billy Hunt)
Member id
UHC-62397-46
Confidence
1
Method
probabilistic
MBR-008450CLM-406432
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002059
Orphan claim re-pointed
Claims processor
CLM-411430 → UHC-61111-61 (Joe Torres)
Member id
UHC-61111-61
Confidence
0.97
Method
deterministic
MBR-010164CLM-411430
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002060
Orphan claim re-pointed
Claims processor
CLM-422863 → UHC-52538-51 (Alan Ford)
Member id
UHC-52538-51
Confidence
1
Method
probabilistic
MBR-028861CLM-422863
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002061
Orphan claim re-pointed
Claims processor
CLM-421417 → UHC-09033-92 (Yuki Contreras)
Member id
UHC-09033-92
Confidence
1
Method
probabilistic
MBR-008381CLM-421417
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002062
Orphan claim re-pointed
Claims processor
CLM-401367 → UHC-86812-10 (Angela Hawkins)
Member id
UHC-86812-10
Confidence
1
Method
probabilistic
MBR-002138CLM-401367
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002063
Orphan claim re-pointed
Claims processor
CLM-421211 → UHC-78273-41 (Steven Price)
Member id
UHC-78273-41
Confidence
1
Method
probabilistic
MBR-011065CLM-421211
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002064
Orphan claim re-pointed
Claims processor
CLM-422270 → UHC-90765-54 (James Hanson)
Member id
UHC-90765-54
Confidence
1
Method
probabilistic
MBR-005594CLM-422270
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002065
Orphan claim re-pointed
Claims processor
CLM-421305 → UHC-17475-99 (Judy Ruiz)
Member id
UHC-17475-99
Confidence
1
Method
probabilistic
MBR-016882CLM-421305
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002066
Orphan claim re-pointed
Claims processor
CLM-424470 → UHC-19581-78 (Richard Guzman)
Member id
UHC-19581-78
Confidence
0.97
Method
deterministic
MBR-035222CLM-424470
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002067
Orphan claim re-pointed
Claims processor
CLM-432250 → UHC-95527-11 (Catherine Romero)
Member id
UHC-95527-11
Confidence
1
Method
probabilistic
MBR-013621CLM-432250
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002068
Orphan claim re-pointed
Claims processor
CLM-420027 → UHC-74272-20 (Austin Hernandez)
Member id
UHC-74272-20
Confidence
1
Method
probabilistic
MBR-032423CLM-420027
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002069
Orphan claim re-pointed
Claims processor
CLM-406229 → UHC-31788-54 (William Contreras)
Member id
UHC-31788-54
Confidence
0.93
Method
probabilistic
MBR-038038CLM-406229
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002070
Orphan claim re-pointed
Claims processor
CLM-431266 → UHC-89349-54 (Priya Fernandez)
Member id
UHC-89349-54
Confidence
1
Method
probabilistic
MBR-002282CLM-431266
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002071
Orphan claim re-pointed
Claims processor
CLM-411175 → UHC-47951-04 (Betty Wheeler)
Member id
UHC-47951-04
Confidence
1
Method
probabilistic
MBR-015334CLM-411175
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002072
Orphan claim re-pointed
Claims processor
CLM-411766 → UHC-94739-65 (Jeffrey Vazquez)
Member id
UHC-94739-65
Confidence
1
Method
probabilistic
MBR-021558CLM-411766
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002073
Orphan claim re-pointed
Claims processor
CLM-419800 → UHC-19446-14 (Diane Reid)
Member id
UHC-19446-14
Confidence
1
Method
probabilistic
MBR-010405CLM-419800
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002074
Orphan claim re-pointed
Claims processor
CLM-414838 → UHC-66059-99 (Lawrence Owens)
Member id
UHC-66059-99
Confidence
1
Method
probabilistic
MBR-028510CLM-414838
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002075
Orphan claim re-pointed
Claims processor
CLM-427951 → UHC-00785-53 (Elijah Gilbert)
Member id
UHC-00785-53
Confidence
1
Method
probabilistic
MBR-039217CLM-427951
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002076
Orphan claim re-pointed
Claims processor
CLM-406781 → UHC-69527-63 (Billy Perez)
Member id
UHC-69527-63
Confidence
0.97
Method
deterministic
MBR-014095CLM-406781
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002077
Orphan claim re-pointed
Claims processor
CLM-403677 → UHC-97161-69 (Raymond Delgado)
Member id
UHC-97161-69
Confidence
1
Method
probabilistic
MBR-017342CLM-403677
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002078
Orphan claim re-pointed
Claims processor
CLM-414347 → UHC-25569-64 (Henry Jenkins)
Member id
UHC-25569-64
Confidence
0.97
Method
deterministic
MBR-010786CLM-414347
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002079
Orphan claim re-pointed
Claims processor
CLM-403203 → UHC-86954-11 (Anthony Knight)
Member id
UHC-86954-11
Confidence
1
Method
probabilistic
MBR-025382CLM-403203
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002080
Orphan claim re-pointed
Claims processor
CLM-402622 → UHC-18828-56 (Luis Vega)
Member id
UHC-18828-56
Confidence
1
Method
probabilistic
MBR-017929CLM-402622
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002081
Orphan claim re-pointed
Claims processor
CLM-423623 → UHC-64772-95 (Ana Arnold)
Member id
UHC-64772-95
Confidence
1
Method
probabilistic
MBR-033692CLM-423623
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002082
Orphan claim re-pointed
Claims processor
CLM-420637 → UHC-46022-88 (Grace Nunez)
Member id
UHC-46022-88
Confidence
0.97
Method
deterministic
MBR-002901CLM-420637
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002083
Orphan claim re-pointed
Claims processor
CLM-402157 → UHC-42957-58 (Luis Sullivan)
Member id
UHC-42957-58
Confidence
1
Method
probabilistic
MBR-010697CLM-402157
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002084
Orphan claim re-pointed
Claims processor
CLM-420696 → UHC-70738-77 (Sarah Hill)
Member id
UHC-70738-77
Confidence
1
Method
probabilistic
MBR-022087CLM-420696
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002085
Orphan claim re-pointed
Claims processor
CLM-422189 → UHC-17881-72 (Raymond Robinson)
Member id
UHC-17881-72
Confidence
0.93
Method
probabilistic
MBR-027154CLM-422189
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002086
Orphan claim re-pointed
Claims processor
CLM-430813 → UHC-14709-75 (Andrea Harrison)
Member id
UHC-14709-75
Confidence
1
Method
probabilistic
MBR-000999CLM-430813
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002087
Orphan claim re-pointed
Claims processor
CLM-416021 → UHC-51511-77 (Mark Hart)
Member id
UHC-51511-77
Confidence
1
Method
probabilistic
MBR-017891CLM-416021
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002088
Orphan claim re-pointed
Claims processor
CLM-420595 → UHC-65148-82 (Evelyn Morrison)
Member id
UHC-65148-82
Confidence
1
Method
probabilistic
MBR-028254CLM-420595
Executed
resolution_agent
2026-10-19 19:54:39
ACT-002089
Orphan claim re-pointed
Claims processor
CLM-410432 → UHC-61792-31 (Catherine Bennett)
Member id
UHC-61792-31
Confidence
0.93
Method
probabilistic
MBR-000458CLM-410432
Executed
resolution_agent
2026-10-19 19:54:39
14,086 rows, page 15 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.