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-008840
Orphan claim re-pointed
Claims processor
CLM-411165 → UHC-69990-78 (Kevin Soot)
Member id
UHC-69990-78
Confidence
0.97
Method
deterministic
MBR-040566CLM-411165
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008841
Orphan claim re-pointed
Claims processor
CLM-404274 → UHC-75366-47 (Andrea Medina)
Member id
UHC-75366-47
Confidence
1
Method
probabilistic
MBR-033426CLM-404274
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008842
Orphan claim re-pointed
Claims processor
CLM-406498 → UHC-76329-93 (Cynthia Price)
Member id
UHC-76329-93
Confidence
1
Method
probabilistic
MBR-010085CLM-406498
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008843
Orphan claim re-pointed
Claims processor
CLM-416936 → UHC-16493-18 (Amber Vasquez)
Member id
UHC-16493-18
Confidence
0.97
Method
deterministic
MBR-008988CLM-416936
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008844
Orphan claim re-pointed
Claims processor
CLM-419847 → UHC-79045-67 (Amy Gonzaales)
Member id
UHC-79045-67
Confidence
0.97
Method
deterministic
MBR-023094CLM-419847
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008845
Orphan claim re-pointed
Claims processor
CLM-403186 → UHC-21353-27 (Yuki Herrera)
Member id
UHC-21353-27
Confidence
0.97
Method
deterministic
MBR-028746CLM-403186
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008846
Orphan claim re-pointed
Claims processor
CLM-409741 → UHC-49250-90 (Charles Taylor)
Member id
UHC-49250-90
Confidence
1
Method
probabilistic
MBR-017077CLM-409741
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008847
Orphan claim re-pointed
Claims processor
CLM-405375 → UHC-20937-43 (Sara Ray)
Member id
UHC-20937-43
Confidence
1
Method
probabilistic
MBR-025596CLM-405375
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008848
Orphan claim re-pointed
Claims processor
CLM-416367 → UHC-43821-91 (Mary Jordan)
Member id
UHC-43821-91
Confidence
1
Method
probabilistic
MBR-006024CLM-416367
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008849
Orphan claim re-pointed
Claims processor
CLM-404538 → UHC-88580-44 (Lisa Silva)
Member id
UHC-88580-44
Confidence
1
Method
probabilistic
MBR-012074CLM-404538
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008850
Orphan claim re-pointed
Claims processor
CLM-419327 → UHC-68157-21 (Ann Hudson)
Member id
UHC-68157-21
Confidence
0.97
Method
deterministic
MBR-002370CLM-419327
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008851
Orphan claim re-pointed
Claims processor
CLM-427802 → UHC-43089-48 (Debra Singh)
Member id
UHC-43089-48
Confidence
1
Method
probabilistic
MBR-015692CLM-427802
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008852
Orphan claim re-pointed
Claims processor
CLM-418778 → UHC-93141-48 (Juan Allen)
Member id
UHC-93141-48
Confidence
0.99
Method
probabilistic
MBR-013610CLM-418778
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008853
Orphan claim re-pointed
Claims processor
CLM-400657 → UHC-49481-03 (Margaret Foster)
Member id
UHC-49481-03
Confidence
1
Method
probabilistic
MBR-000505CLM-400657
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008854
Orphan claim re-pointed
Claims processor
CLM-417513 → UHC-64553-99 (Russell Garcia)
Member id
UHC-64553-99
Confidence
0.94
Method
probabilistic
MBR-002993CLM-417513
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008855
Orphan claim re-pointed
Claims processor
CLM-422421 → UHC-94453-11 (Thomas Baker)
Member id
UHC-94453-11
Confidence
1
Method
probabilistic
MBR-003513CLM-422421
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008856
Orphan claim re-pointed
Claims processor
CLM-424423 → UHC-40750-03 (Amy Medina)
Member id
UHC-40750-03
Confidence
1
Method
probabilistic
MBR-016925CLM-424423
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008857
Orphan claim re-pointed
Claims processor
CLM-410204 → UHC-71698-20 (Julia Wong)
Member id
UHC-71698-20
Confidence
1
Method
probabilistic
MBR-033206CLM-410204
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008858
Orphan claim re-pointed
Claims processor
CLM-405828 → UHC-00903-59 (Grace Vazquez)
Member id
UHC-00903-59
Confidence
1
Method
probabilistic
MBR-031604CLM-405828
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008859
Orphan claim re-pointed
Claims processor
CLM-426698 → UHC-39362-82 (Dennis Harris)
Member id
UHC-39362-82
Confidence
1
Method
probabilistic
MBR-016293CLM-426698
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008860
Orphan claim re-pointed
Claims processor
CLM-414404 → UHC-68640-21 (Dennis Jimenez)
Member id
UHC-68640-21
Confidence
0.99
Method
probabilistic
MBR-009609CLM-414404
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008861
Orphan claim re-pointed
Claims processor
CLM-425967 → UHC-84938-93 (Sophia Walker)
Member id
UHC-84938-93
Confidence
1
Method
probabilistic
MBR-001014CLM-425967
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008862
Orphan claim re-pointed
Claims processor
CLM-425879 → UHC-17655-21 (Ethan Chavez)
Member id
UHC-17655-21
Confidence
1
Method
probabilistic
MBR-014869CLM-425879
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008863
Orphan claim re-pointed
Claims processor
CLM-417876 → UHC-17947-20 (Jessica Garza)
Member id
UHC-17947-20
Confidence
1
Method
probabilistic
MBR-025976CLM-417876
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008864
Orphan claim re-pointed
Claims processor
CLM-422659 → UHC-69799-61 (Melissa Dean)
Member id
UHC-69799-61
Confidence
1
Method
probabilistic
MBR-009071CLM-422659
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008865
Orphan claim re-pointed
Claims processor
CLM-401314 → UHC-98286-73 (Ahmed Schultz)
Member id
UHC-98286-73
Confidence
0.94
Method
probabilistic
MBR-004837CLM-401314
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008866
Orphan claim re-pointed
Claims processor
CLM-431897 → UHC-00300-86 (Melissa Medina)
Member id
UHC-00300-86
Confidence
0.97
Method
deterministic
MBR-004470CLM-431897
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008867
Orphan claim re-pointed
Claims processor
CLM-401801 → UHC-51799-64 (Kayla Lee)
Member id
UHC-51799-64
Confidence
1
Method
probabilistic
MBR-009866CLM-401801
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008868
Orphan claim re-pointed
Claims processor
CLM-405204 → UHC-75488-97 (Emma Smith)
Member id
UHC-75488-97
Confidence
1
Method
probabilistic
MBR-018278CLM-405204
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008869
Orphan claim re-pointed
Claims processor
CLM-431592 → UHC-28041-40 (Mary Hudson)
Member id
UHC-28041-40
Confidence
1
Method
probabilistic
MBR-005011CLM-431592
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008870
Orphan claim re-pointed
Claims processor
CLM-409138 → UHC-74963-28 (Bruce Adams)
Member id
UHC-74963-28
Confidence
0.97
Method
deterministic
MBR-016420CLM-409138
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008871
Orphan claim re-pointed
Claims processor
CLM-418405 → UHC-83336-39 (Deborah Vargas)
Member id
UHC-83336-39
Confidence
0.97
Method
deterministic
MBR-011491CLM-418405
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008872
Orphan claim re-pointed
Claims processor
CLM-423493 → UHC-35857-72 (Lauren Cooper)
Member id
UHC-35857-72
Confidence
1
Method
probabilistic
MBR-007216CLM-423493
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008873
Orphan claim re-pointed
Claims processor
CLM-429165 → UHC-70952-79 (Nathan Peters)
Member id
UHC-70952-79
Confidence
0.99
Method
probabilistic
MBR-003072CLM-429165
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008874
Orphan claim re-pointed
Claims processor
CLM-404755 → UHC-91703-40 (Jasoon Booyd)
Member id
UHC-91703-40
Confidence
0.97
Method
deterministic
MBR-025505CLM-404755
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008875
Orphan claim re-pointed
Claims processor
CLM-431426 → UHC-10708-39 (Lucia Foster)
Member id
UHC-10708-39
Confidence
0.92
Method
probabilistic
MBR-015501CLM-431426
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008876
Orphan claim re-pointed
Claims processor
CLM-415210 → UHC-11141-74 (Lucia Holmes)
Member id
UHC-11141-74
Confidence
1
Method
probabilistic
MBR-019290CLM-415210
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008877
Orphan claim re-pointed
Claims processor
CLM-431194 → UHC-73306-15 (Alexis Elliott)
Member id
UHC-73306-15
Confidence
1
Method
probabilistic
MBR-003622CLM-431194
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008878
Orphan claim re-pointed
Claims processor
CLM-421947 → UHC-15752-28 (Cheryl Murphy)
Member id
UHC-15752-28
Confidence
1
Method
probabilistic
MBR-023865CLM-421947
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008879
Orphan claim re-pointed
Claims processor
CLM-415059 → UHC-00530-80 (Diana Russell)
Member id
UHC-00530-80
Confidence
1
Method
probabilistic
MBR-028526CLM-415059
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008880
Orphan claim re-pointed
Claims processor
CLM-424335 → UHC-51207-32 (Wei Vazquez)
Member id
UHC-51207-32
Confidence
1
Method
probabilistic
MBR-018857CLM-424335
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008881
Orphan claim re-pointed
Claims processor
CLM-413820 → UHC-71548-92 (Nicholas Wells)
Member id
UHC-71548-92
Confidence
1
Method
probabilistic
MBR-030049CLM-413820
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008882
Orphan claim re-pointed
Claims processor
CLM-402904 → UHC-84406-53 (Alexander Contreras)
Member id
UHC-84406-53
Confidence
1
Method
probabilistic
MBR-002419CLM-402904
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008883
Orphan claim re-pointed
Claims processor
CLM-412292 → UHC-44106-88 (Virginia Ross)
Member id
UHC-44106-88
Confidence
0.97
Method
deterministic
MBR-020520CLM-412292
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008884
Orphan claim re-pointed
Claims processor
CLM-411332 → UHC-83800-64 (Sharon Hill)
Member id
UHC-83800-64
Confidence
1
Method
probabilistic
MBR-026571CLM-411332
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008885
Orphan claim re-pointed
Claims processor
CLM-405748 → UHC-92455-51 (Jacob Obrien)
Member id
UHC-92455-51
Confidence
0.98
Method
probabilistic
MBR-004420CLM-405748
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008886
Orphan claim re-pointed
Claims processor
CLM-419044 → UHC-95264-09 (Donald Reyes)
Member id
UHC-95264-09
Confidence
1
Method
probabilistic
MBR-013630CLM-419044
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008887
Orphan claim re-pointed
Claims processor
CLM-402258 → UHC-88172-45 (Lawrence Montgomery)
Member id
UHC-88172-45
Confidence
1
Method
probabilistic
MBR-007521CLM-402258
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008888
Orphan claim re-pointed
Claims processor
CLM-421191 → UHC-63850-64 (Sara Wood)
Member id
UHC-63850-64
Confidence
1
Method
probabilistic
MBR-015160CLM-421191
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008889
Orphan claim re-pointed
Claims processor
CLM-412009 → UHC-28458-04 (Gerald Jones)
Member id
UHC-28458-04
Confidence
0.99
Method
probabilistic
MBR-007936CLM-412009
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 151 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.