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-009140
Orphan claim re-pointed
Claims processor
CLM-402501 → UHC-81063-83 (Lauren Nunez)
Member id
UHC-81063-83
Confidence
1
Method
probabilistic
MBR-002587CLM-402501
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009141
Orphan claim re-pointed
Claims processor
CLM-401180 → UHC-89423-86 (Diego Bishop)
Member id
UHC-89423-86
Confidence
1
Method
probabilistic
MBR-022430CLM-401180
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009142
Orphan claim re-pointed
Claims processor
CLM-425712 → UHC-99938-63 (Ronald Morales)
Member id
UHC-99938-63
Confidence
0.97
Method
deterministic
MBR-001108CLM-425712
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009143
Orphan claim re-pointed
Claims processor
CLM-419572 → UHC-36595-86 (Eugene Perez)
Member id
UHC-36595-86
Confidence
1
Method
probabilistic
MBR-025903CLM-419572
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009144
Orphan claim re-pointed
Claims processor
CLM-404179 → UHC-51717-16 (Willie Price)
Member id
UHC-51717-16
Confidence
1
Method
probabilistic
MBR-014007CLM-404179
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009145
Orphan claim re-pointed
Claims processor
CLM-417584 → UHC-05122-10 (Mateo Willis)
Member id
UHC-05122-10
Confidence
0.97
Method
deterministic
MBR-004752CLM-417584
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009146
Orphan claim re-pointed
Claims processor
CLM-423056 → UHC-74392-69 (Ben Barnes)
Member id
UHC-74392-69
Confidence
0.92
Method
probabilistic
MBR-026241CLM-423056
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009147
Orphan claim re-pointed
Claims processor
CLM-410460 → UHC-03711-37 (Zachary Green)
Member id
UHC-03711-37
Confidence
1
Method
probabilistic
MBR-004833CLM-410460
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009148
Orphan claim re-pointed
Claims processor
CLM-429274 → UHC-64162-90 (Joyce Howard)
Member id
UHC-64162-90
Confidence
0.98
Method
probabilistic
MBR-009320CLM-429274
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009149
Orphan claim re-pointed
Claims processor
CLM-421505 → UHC-98726-28 (Donald Wite)
Member id
UHC-98726-28
Confidence
0.99
Method
probabilistic
MBR-010255CLM-421505
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009150
Orphan claim re-pointed
Claims processor
CLM-426310 → UHC-51764-25 (Olivia Bailey)
Member id
UHC-51764-25
Confidence
0.97
Method
deterministic
MBR-010013CLM-426310
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009151
Orphan claim re-pointed
Claims processor
CLM-425826 → UHC-25328-51 (Ahmed Barnes)
Member id
UHC-25328-51
Confidence
1
Method
probabilistic
MBR-029675CLM-425826
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009152
Orphan claim re-pointed
Claims processor
CLM-428079 → UHC-03389-40 (Cheryl Martinez)
Member id
UHC-03389-40
Confidence
1
Method
probabilistic
MBR-024025CLM-428079
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009153
Orphan claim re-pointed
Claims processor
CLM-414867 → UHC-70103-18 (Jeremy Williamson)
Member id
UHC-70103-18
Confidence
1
Method
probabilistic
MBR-006283CLM-414867
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009154
Orphan claim re-pointed
Claims processor
CLM-411543 → UHC-51126-87 (Jack Carter)
Member id
UHC-51126-87
Confidence
0.93
Method
probabilistic
MBR-006525CLM-411543
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009155
Orphan claim re-pointed
Claims processor
CLM-406414 → UHC-00910-34 (Anthony Barnes)
Member id
UHC-00910-34
Confidence
1
Method
probabilistic
MBR-024356CLM-406414
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009156
Orphan claim re-pointed
Claims processor
CLM-427004 → UHC-89336-04 (Nathan Gutierrez)
Member id
UHC-89336-04
Confidence
0.97
Method
deterministic
MBR-037495CLM-427004
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009157
Orphan claim re-pointed
Claims processor
CLM-400620 → UHC-65560-71 (Gary Gutierrez)
Member id
UHC-65560-71
Confidence
0.93
Method
probabilistic
MBR-002163CLM-400620
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009158
Orphan claim re-pointed
Claims processor
CLM-403919 → UHC-05862-91 (Zachary Carlson)
Member id
UHC-05862-91
Confidence
1
Method
probabilistic
MBR-008576CLM-403919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009159
Orphan claim re-pointed
Claims processor
CLM-431896 → UHC-00300-86 (Melissa Medina)
Member id
UHC-00300-86
Confidence
1
Method
probabilistic
MBR-004470CLM-431896
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009160
Orphan claim re-pointed
Claims processor
CLM-410121 → UHC-07328-18 (Dylan Oliver)
Member id
UHC-07328-18
Confidence
0.97
Method
deterministic
MBR-027262CLM-410121
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009161
Orphan claim re-pointed
Claims processor
CLM-419368 → UHC-56320-70 (Sean Nunez)
Member id
UHC-56320-70
Confidence
1
Method
probabilistic
MBR-028426CLM-419368
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009162
Orphan claim re-pointed
Claims processor
CLM-421653 → UHC-48927-65 (James Maldonado)
Member id
UHC-48927-65
Confidence
1
Method
probabilistic
MBR-027302CLM-421653
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009163
Orphan claim re-pointed
Claims processor
CLM-409302 → UHC-53249-64 (Nataliie Wells)
Member id
UHC-53249-64
Confidence
0.97
Method
deterministic
MBR-002958CLM-409302
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009164
Orphan claim re-pointed
Claims processor
CLM-430874 → UHC-99631-53 (Stephen Padilla)
Member id
UHC-99631-53
Confidence
1
Method
probabilistic
MBR-032454CLM-430874
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009165
Orphan claim re-pointed
Claims processor
CLM-419521 → UHC-85777-05 (Peter Castillo)
Member id
UHC-85777-05
Confidence
1
Method
probabilistic
MBR-000993CLM-419521
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009166
Orphan claim re-pointed
Claims processor
CLM-424577 → UHC-88200-35 (Kelly Shaw)
Member id
UHC-88200-35
Confidence
1
Method
probabilistic
MBR-000367CLM-424577
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009167
Orphan claim re-pointed
Claims processor
CLM-420406 → UHC-26372-60 (Sara Harvey)
Member id
UHC-26372-60
Confidence
1
Method
probabilistic
MBR-013861CLM-420406
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009168
Orphan claim re-pointed
Claims processor
CLM-407921 → UHC-31162-50 (Randy Murphy)
Member id
UHC-31162-50
Confidence
1
Method
probabilistic
MBR-020827CLM-407921
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009169
Orphan claim re-pointed
Claims processor
CLM-413440 → UHC-63823-65 (Bruce Garza)
Member id
UHC-63823-65
Confidence
1
Method
probabilistic
MBR-015951CLM-413440
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009170
Orphan claim re-pointed
Claims processor
CLM-406508 → UHC-92335-51 (Jordan Garcia)
Member id
UHC-92335-51
Confidence
1
Method
probabilistic
MBR-010350CLM-406508
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009171
Orphan claim re-pointed
Claims processor
CLM-410569 → UHC-43471-66 (Marilyn Patterson)
Member id
UHC-43471-66
Confidence
1
Method
probabilistic
MBR-002446CLM-410569
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009172
Orphan claim re-pointed
Claims processor
CLM-419654 → UHC-03351-44 (Lisa Vargas)
Member id
UHC-03351-44
Confidence
0.97
Method
deterministic
MBR-021738CLM-419654
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009173
Orphan claim re-pointed
Claims processor
CLM-406422 → UHC-16872-58 (Stephanie Burns)
Member id
UHC-16872-58
Confidence
1
Method
probabilistic
MBR-016389CLM-406422
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009174
Orphan claim re-pointed
Claims processor
CLM-405116 → UHC-51047-78 (Jesse Carroll)
Member id
UHC-51047-78
Confidence
0.97
Method
deterministic
MBR-024180CLM-405116
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009175
Orphan claim re-pointed
Claims processor
CLM-405707 → UHC-61535-22 (Arjun Wallace)
Member id
UHC-61535-22
Confidence
1
Method
probabilistic
MBR-001201CLM-405707
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009176
Orphan claim re-pointed
Claims processor
CLM-409067 → UHC-60107-66 (Stephen Scott)
Member id
UHC-60107-66
Confidence
1
Method
probabilistic
MBR-005964CLM-409067
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009177
Orphan claim re-pointed
Claims processor
CLM-420964 → UHC-35949-93 (Arthur Kelley)
Member id
UHC-35949-93
Confidence
1
Method
probabilistic
MBR-024768CLM-420964
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009178
Orphan claim re-pointed
Claims processor
CLM-428905 → UHC-05355-82 (Joyce Mendoza)
Member id
UHC-05355-82
Confidence
0.97
Method
deterministic
MBR-016491CLM-428905
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009179
Orphan claim re-pointed
Claims processor
CLM-401360 → UHC-95131-79 (Barbara Taylor)
Member id
UHC-95131-79
Confidence
1
Method
probabilistic
MBR-024738CLM-401360
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009180
Orphan claim re-pointed
Claims processor
CLM-406775 → UHC-24250-02 (Carl Owens)
Member id
UHC-24250-02
Confidence
1
Method
probabilistic
MBR-006677CLM-406775
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009181
Orphan claim re-pointed
Claims processor
CLM-408204 → UHC-17925-71 (Sarah Barnes)
Member id
UHC-17925-71
Confidence
0.97
Method
deterministic
MBR-037496CLM-408204
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009182
Orphan claim re-pointed
Claims processor
CLM-418351 → UHC-74847-84 (Bobby Wright)
Member id
UHC-74847-84
Confidence
1
Method
probabilistic
MBR-005523CLM-418351
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009183
Orphan claim re-pointed
Claims processor
CLM-402965 → UHC-44414-07 (Julie Boyd)
Member id
UHC-44414-07
Confidence
0.97
Method
deterministic
MBR-019470CLM-402965
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009184
Orphan claim re-pointed
Claims processor
CLM-431158 → UHC-90196-95 (Ethan Thompson)
Member id
UHC-90196-95
Confidence
0.97
Method
deterministic
MBR-035164CLM-431158
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009185
Orphan claim re-pointed
Claims processor
CLM-426309 → UHC-51764-25 (Olivia Bailey)
Member id
UHC-51764-25
Confidence
0.94
Method
probabilistic
MBR-010013CLM-426309
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009186
Orphan claim re-pointed
Claims processor
CLM-400892 → UHC-11140-30 (Amber Johnston)
Member id
UHC-11140-30
Confidence
0.97
Method
deterministic
MBR-019687CLM-400892
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009187
Orphan claim re-pointed
Claims processor
CLM-415568 → UHC-04897-53 (Benjamin Singh)
Member id
UHC-04897-53
Confidence
0.97
Method
deterministic
MBR-003980CLM-415568
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009188
Orphan claim re-pointed
Claims processor
CLM-408893 → UHC-65157-91 (Jean Carr)
Member id
UHC-65157-91
Confidence
1
Method
probabilistic
MBR-004956CLM-408893
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009189
Orphan claim re-pointed
Claims processor
CLM-425739 → UHC-85052-29 (Luis Dominguez)
Member id
UHC-85052-29
Confidence
1
Method
probabilistic
MBR-016468CLM-425739
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 157 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.