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-008890
Orphan claim re-pointed
Claims processor
CLM-426831 → UHC-12324-03 (Kathryn Payne)
Member id
UHC-12324-03
Confidence
1
Method
probabilistic
MBR-028845CLM-426831
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008891
Orphan claim re-pointed
Claims processor
CLM-416092 → UHC-94684-51 (Daniel Oliver)
Member id
UHC-94684-51
Confidence
1
Method
probabilistic
MBR-030465CLM-416092
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008892
Orphan claim re-pointed
Claims processor
CLM-400378 → UHC-39117-66 (Vicky Lynch)
Member id
UHC-39117-66
Confidence
0.87
Method
probabilistic
MBR-030704CLM-400378
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008893
Orphan claim re-pointed
Claims processor
CLM-410294 → UHC-42797-52 (Gabriel Padilla)
Member id
UHC-42797-52
Confidence
1
Method
probabilistic
MBR-040411CLM-410294
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008894
Orphan claim re-pointed
Claims processor
CLM-405205 → UHC-99813-04 (Brittany Campbell)
Member id
UHC-99813-04
Confidence
0.99
Method
probabilistic
MBR-015276CLM-405205
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008895
Orphan claim re-pointed
Claims processor
CLM-410339 → UHC-64318-81 (Rebecca Harris)
Member id
UHC-64318-81
Confidence
1
Method
probabilistic
MBR-007325CLM-410339
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008896
Orphan claim re-pointed
Claims processor
CLM-411589 → UHC-79519-71 (Heather Mendoza)
Member id
UHC-79519-71
Confidence
0.97
Method
deterministic
MBR-027372CLM-411589
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008897
Orphan claim re-pointed
Claims processor
CLM-404194 → UHC-39484-68 (Jason Green)
Member id
UHC-39484-68
Confidence
1
Method
probabilistic
MBR-002915CLM-404194
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008898
Orphan claim re-pointed
Claims processor
CLM-401175 → UHC-95934-32 (Emma Vasquez)
Member id
UHC-95934-32
Confidence
1
Method
probabilistic
MBR-023266CLM-401175
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008899
Orphan claim re-pointed
Claims processor
CLM-426804 → UHC-39743-86 (Hannah Chavez)
Member id
UHC-39743-86
Confidence
0.93
Method
probabilistic
MBR-018559CLM-426804
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008900
Orphan claim re-pointed
Claims processor
CLM-408854 → UHC-41752-65 (Martha Rogers)
Member id
UHC-41752-65
Confidence
1
Method
probabilistic
MBR-022671CLM-408854
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008901
Orphan claim re-pointed
Claims processor
CLM-405533 → UHC-59294-39 (Judith Riley)
Member id
UHC-59294-39
Confidence
1
Method
probabilistic
MBR-043332CLM-405533
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008902
Orphan claim re-pointed
Claims processor
CLM-411621 → UHC-88620-39 (Brandon Park)
Member id
UHC-88620-39
Confidence
1
Method
probabilistic
MBR-025220CLM-411621
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008903
Orphan claim re-pointed
Claims processor
CLM-420017 → UHC-19952-85 (Santiago Jimenez)
Member id
UHC-19952-85
Confidence
0.97
Method
deterministic
MBR-004929CLM-420017
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008904
Orphan claim re-pointed
Claims processor
CLM-409905 → UHC-88592-44 (Amber Howell)
Member id
UHC-88592-44
Confidence
1
Method
probabilistic
MBR-013614CLM-409905
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008905
Orphan claim re-pointed
Claims processor
CLM-429936 → UHC-24155-05 (Walter Flores)
Member id
UHC-24155-05
Confidence
1
Method
probabilistic
MBR-012400CLM-429936
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008906
Orphan claim re-pointed
Claims processor
CLM-426145 → UHC-78735-87 (Diana Mills)
Member id
UHC-78735-87
Confidence
1
Method
probabilistic
MBR-033154CLM-426145
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008907
Orphan claim re-pointed
Claims processor
CLM-413768 → UHC-95142-63 (Judy Green)
Member id
UHC-95142-63
Confidence
1
Method
probabilistic
MBR-026820CLM-413768
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008908
Orphan claim re-pointed
Claims processor
CLM-431875 → UHC-18805-90 (Patricia Rice)
Member id
UHC-18805-90
Confidence
0.97
Method
deterministic
MBR-032518CLM-431875
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008909
Orphan claim re-pointed
Claims processor
CLM-418587 → UHC-53202-94 (Debra Ortega)
Member id
UHC-53202-94
Confidence
1
Method
probabilistic
MBR-026252CLM-418587
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008910
Orphan claim re-pointed
Claims processor
CLM-425941 → UHC-85599-20 (Ralph Andrews)
Member id
UHC-85599-20
Confidence
1
Method
probabilistic
MBR-001382CLM-425941
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008911
Orphan claim re-pointed
Claims processor
CLM-401656 → UHC-68627-66 (Albert Salazar)
Member id
UHC-68627-66
Confidence
0.93
Method
probabilistic
MBR-011721CLM-401656
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008912
Orphan claim re-pointed
Claims processor
CLM-406268 → UHC-99893-15 (Fatima Nguyen)
Member id
UHC-99893-15
Confidence
1
Method
probabilistic
MBR-017820CLM-406268
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008913
Orphan claim re-pointed
Claims processor
CLM-428489 → UHC-71793-40 (Beverly Clark)
Member id
UHC-71793-40
Confidence
0.97
Method
deterministic
MBR-027358CLM-428489
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008914
Orphan claim re-pointed
Claims processor
CLM-429184 → UHC-67446-61 (Luis Castro)
Member id
UHC-67446-61
Confidence
1
Method
probabilistic
MBR-008439CLM-429184
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008915
Orphan claim re-pointed
Claims processor
CLM-401616 → UHC-96989-32 (Sophia Fox)
Member id
UHC-96989-32
Confidence
1
Method
probabilistic
MBR-001845CLM-401616
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008916
Orphan claim re-pointed
Claims processor
CLM-422032 → UHC-17963-76 (Brian Coleman)
Member id
UHC-17963-76
Confidence
1
Method
probabilistic
MBR-009350CLM-422032
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008917
Orphan claim re-pointed
Claims processor
CLM-408392 → UHC-54563-08 (Ashley Olson)
Member id
UHC-54563-08
Confidence
1
Method
probabilistic
MBR-000382CLM-408392
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008918
Orphan claim re-pointed
Claims processor
CLM-400374 → UHC-12398-94 (Gloria Woods)
Member id
UHC-12398-94
Confidence
1
Method
probabilistic
MBR-007311CLM-400374
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008919
Orphan claim re-pointed
Claims processor
CLM-432549 → UHC-03633-88 (Russell Jacobs)
Member id
UHC-03633-88
Confidence
1
Method
probabilistic
MBR-003147CLM-432549
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008920
Orphan claim re-pointed
Claims processor
CLM-430836 → UHC-38799-01 (Santos Grace)
Member id
UHC-38799-01
Confidence
0.98
Method
probabilistic
MBR-002834CLM-430836
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008921
Orphan claim re-pointed
Claims processor
CLM-422487 → UHC-65746-05 (Tyler Mason)
Member id
UHC-65746-05
Confidence
0.97
Method
deterministic
MBR-019155CLM-422487
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008922
Orphan claim re-pointed
Claims processor
CLM-426701 → UHC-42593-03 (Catherine Dean)
Member id
UHC-42593-03
Confidence
0.97
Method
deterministic
MBR-016106CLM-426701
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008923
Orphan claim re-pointed
Claims processor
CLM-401032 → UHC-92382-34 (Kelly Robertson)
Member id
UHC-92382-34
Confidence
1
Method
probabilistic
MBR-012452CLM-401032
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008924
Orphan claim re-pointed
Claims processor
CLM-407204 → UHC-81858-35 (Janet Boyd)
Member id
UHC-81858-35
Confidence
1
Method
probabilistic
MBR-014592CLM-407204
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008925
Orphan claim re-pointed
Claims processor
CLM-417335 → UHC-24397-54 (Matthew Rice)
Member id
UHC-24397-54
Confidence
0.97
Method
deterministic
MBR-019363CLM-417335
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008926
Orphan claim re-pointed
Claims processor
CLM-424684 → UHC-47674-88 (William Rivera)
Member id
UHC-47674-88
Confidence
1
Method
probabilistic
MBR-007018CLM-424684
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008927
Orphan claim re-pointed
Claims processor
CLM-411087 → UHC-55156-14 (Lori Hawkins)
Member id
UHC-55156-14
Confidence
1
Method
probabilistic
MBR-014035CLM-411087
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008928
Orphan claim re-pointed
Claims processor
CLM-401260 → UHC-59285-16 (Nancy Delgado)
Member id
UHC-59285-16
Confidence
1
Method
probabilistic
MBR-003675CLM-401260
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008929
Orphan claim re-pointed
Claims processor
CLM-416488 → UHC-71437-69 (Anthony Weaver)
Member id
UHC-71437-69
Confidence
1.00
Method
probabilistic
MBR-008744CLM-416488
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008930
Orphan claim re-pointed
Claims processor
CLM-425887 → UHC-29311-43 (Nathan Alvarez)
Member id
UHC-29311-43
Confidence
1
Method
probabilistic
MBR-002249CLM-425887
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008931
Orphan claim re-pointed
Claims processor
CLM-416753 → UHC-79202-96 (Danielle Garza)
Member id
UHC-79202-96
Confidence
1
Method
probabilistic
MBR-018245CLM-416753
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008932
Orphan claim re-pointed
Claims processor
CLM-404728 → UHC-29195-03 (Jesse Hernandez)
Member id
UHC-29195-03
Confidence
1
Method
probabilistic
MBR-017638CLM-404728
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008933
Orphan claim re-pointed
Claims processor
CLM-431240 → UHC-98819-75 (Mariana Cook)
Member id
UHC-98819-75
Confidence
1
Method
probabilistic
MBR-024040CLM-431240
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008934
Orphan claim re-pointed
Claims processor
CLM-414036 → UHC-13671-78 (Christine Bryant)
Member id
UHC-13671-78
Confidence
1
Method
probabilistic
MBR-000914CLM-414036
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008935
Orphan claim re-pointed
Claims processor
CLM-404410 → UHC-78331-45 (Matthew White)
Member id
UHC-78331-45
Confidence
1
Method
probabilistic
MBR-001306CLM-404410
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008936
Orphan claim re-pointed
Claims processor
CLM-407556 → UHC-58273-59 (Laura Gonzales)
Member id
UHC-58273-59
Confidence
1
Method
probabilistic
MBR-021522CLM-407556
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008937
Orphan claim re-pointed
Claims processor
CLM-407093 → UHC-76888-73 (Joseph Wheeler)
Member id
UHC-76888-73
Confidence
1
Method
probabilistic
MBR-008315CLM-407093
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008938
Orphan claim re-pointed
Claims processor
CLM-427498 → UHC-06392-96 (Yuki Burton)
Member id
UHC-06392-96
Confidence
0.97
Method
deterministic
MBR-005352CLM-427498
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008939
Orphan claim re-pointed
Claims processor
CLM-425943 → UHC-85599-20 (Ralph Andrews)
Member id
UHC-85599-20
Confidence
1
Method
probabilistic
MBR-001382CLM-425943
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 152 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.