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-009340
Orphan claim re-pointed
Claims processor
CLM-422749 → UHC-67292-12 (Julie Banks)
Member id
UHC-67292-12
Confidence
1
Method
probabilistic
MBR-011140CLM-422749
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009341
Orphan claim re-pointed
Claims processor
CLM-430012 → UHC-62291-99 (Larry Garcia)
Member id
UHC-62291-99
Confidence
1
Method
probabilistic
MBR-031412CLM-430012
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009342
Orphan claim re-pointed
Claims processor
CLM-402421 → UHC-72475-98 (Lauren Carroll)
Member id
UHC-72475-98
Confidence
0.97
Method
deterministic
MBR-009567CLM-402421
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009343
Orphan claim re-pointed
Claims processor
CLM-422050 → UHC-03245-02 (Sharon Bennett)
Member id
UHC-03245-02
Confidence
0.86
Method
probabilistic
MBR-041123CLM-422050
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009344
Orphan claim re-pointed
Claims processor
CLM-401772 → UHC-15533-67 (David Turner)
Member id
UHC-15533-67
Confidence
1
Method
probabilistic
MBR-007346CLM-401772
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009345
Orphan claim re-pointed
Claims processor
CLM-400305 → UHC-96259-40 (John Brooks)
Member id
UHC-96259-40
Confidence
1
Method
probabilistic
MBR-007877CLM-400305
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009346
Orphan claim re-pointed
Claims processor
CLM-422113 → UHC-73625-05 (Gloria Brooks)
Member id
UHC-73625-05
Confidence
1
Method
probabilistic
MBR-017971CLM-422113
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009347
Orphan claim re-pointed
Claims processor
CLM-426181 → UHC-01358-75 (Kevin Tucker)
Member id
UHC-01358-75
Confidence
1
Method
probabilistic
MBR-004967CLM-426181
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009348
Orphan claim re-pointed
Claims processor
CLM-432132 → UHC-27136-95 (Logan Ortiz)
Member id
UHC-27136-95
Confidence
0.97
Method
deterministic
MBR-015725CLM-432132
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009349
Orphan claim re-pointed
Claims processor
CLM-426933 → UHC-99283-82 (Michael Olson)
Member id
UHC-99283-82
Confidence
1
Method
probabilistic
MBR-036600CLM-426933
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009350
Orphan claim re-pointed
Claims processor
CLM-402855 → UHC-25785-59 (Logan James)
Member id
UHC-25785-59
Confidence
1
Method
probabilistic
MBR-023313CLM-402855
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009351
Orphan claim re-pointed
Claims processor
CLM-413944 → UHC-18925-10 (Margaret Schmidt)
Member id
UHC-18925-10
Confidence
1
Method
probabilistic
MBR-005047CLM-413944
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009352
Orphan claim re-pointed
Claims processor
CLM-407692 → UHC-87366-53 (Arthur Espinoza)
Member id
UHC-87366-53
Confidence
1
Method
probabilistic
MBR-011847CLM-407692
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009353
Orphan claim re-pointed
Claims processor
CLM-417125 → UHC-85213-42 (Jordan Carr)
Member id
UHC-85213-42
Confidence
1
Method
probabilistic
MBR-009693CLM-417125
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009354
Orphan claim re-pointed
Claims processor
CLM-418159 → UHC-29563-18 (Valentina Olson)
Member id
UHC-29563-18
Confidence
0.94
Method
probabilistic
MBR-031166CLM-418159
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009355
Orphan claim re-pointed
Claims processor
CLM-406590 → UHC-93344-27 (Mateo Castro)
Member id
UHC-93344-27
Confidence
1
Method
probabilistic
MBR-015230CLM-406590
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009356
Orphan claim re-pointed
Claims processor
CLM-423053 → UHC-92140-80 (Dennis Ward)
Member id
UHC-92140-80
Confidence
1
Method
probabilistic
MBR-016545CLM-423053
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009357
Orphan claim re-pointed
Claims processor
CLM-407247 → UHC-70367-18 (Grace Hayes)
Member id
UHC-70367-18
Confidence
1
Method
probabilistic
MBR-014001CLM-407247
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009358
Orphan claim re-pointed
Claims processor
CLM-415613 → UHC-61579-57 (Beverly Hunter)
Member id
UHC-61579-57
Confidence
1
Method
probabilistic
MBR-017559CLM-415613
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009359
Orphan claim re-pointed
Claims processor
CLM-407930 → UHC-02009-30 (Diego Bryant)
Member id
UHC-02009-30
Confidence
1
Method
probabilistic
MBR-029185CLM-407930
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009360
Orphan claim re-pointed
Claims processor
CLM-414910 → UHC-52031-57 (Maria Warren)
Member id
UHC-52031-57
Confidence
1
Method
probabilistic
MBR-004228CLM-414910
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009361
Orphan claim re-pointed
Claims processor
CLM-401357 → UHC-15221-74 (Jesse Kelly)
Member id
UHC-15221-74
Confidence
1
Method
probabilistic
MBR-020206CLM-401357
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009362
Orphan claim re-pointed
Claims processor
CLM-407933 → UHC-72108-02 (Cynthia Lucas)
Member id
UHC-72108-02
Confidence
1
Method
probabilistic
MBR-018739CLM-407933
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009363
Orphan claim re-pointed
Claims processor
CLM-413756 → UHC-36242-97 (Cheryl Peterson)
Member id
UHC-36242-97
Confidence
0.97
Method
deterministic
MBR-014360CLM-413756
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009364
Orphan claim re-pointed
Claims processor
CLM-405691 → UHC-87845-70 (Santiago Mendoza)
Member id
UHC-87845-70
Confidence
1
Method
probabilistic
MBR-026193CLM-405691
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009365
Orphan claim re-pointed
Claims processor
CLM-421675 → UHC-81905-48 (Justin Barnes)
Member id
UHC-81905-48
Confidence
1
Method
probabilistic
MBR-016438CLM-421675
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009366
Orphan claim re-pointed
Claims processor
CLM-424993 → UHC-79322-77 (Samuel Russell)
Member id
UHC-79322-77
Confidence
0.97
Method
deterministic
MBR-010424CLM-424993
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009367
Orphan claim re-pointed
Claims processor
CLM-432409 → UHC-65037-61 (Jessica Butler)
Member id
UHC-65037-61
Confidence
1
Method
probabilistic
MBR-000105CLM-432409
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009368
Orphan claim re-pointed
Claims processor
CLM-426841 → UHC-88130-93 (Danielle Reynolds)
Member id
UHC-88130-93
Confidence
1
Method
probabilistic
MBR-020961CLM-426841
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009369
Orphan claim re-pointed
Claims processor
CLM-431825 → UHC-65217-11 (Charles Burke)
Member id
UHC-65217-11
Confidence
0.94
Method
probabilistic
MBR-005997CLM-431825
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009370
Orphan claim re-pointed
Claims processor
CLM-401230 → UHC-81424-76 (Yuki Stone)
Member id
UHC-81424-76
Confidence
1
Method
probabilistic
MBR-015578CLM-401230
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009371
Orphan claim re-pointed
Claims processor
CLM-411515 → UHC-90578-64 (Carl McCoy)
Member id
UHC-90578-64
Confidence
1
Method
probabilistic
MBR-023984CLM-411515
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009372
Orphan claim re-pointed
Claims processor
CLM-410422 → UHC-25604-98 (Ethan Grant)
Member id
UHC-25604-98
Confidence
1
Method
probabilistic
MBR-002277CLM-410422
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009373
Orphan claim re-pointed
Claims processor
CLM-432775 → UHC-11018-53 (Mason Washington)
Member id
UHC-11018-53
Confidence
0.99
Method
probabilistic
MBR-010900CLM-432775
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009374
Orphan claim re-pointed
Claims processor
CLM-432571 → UHC-58693-80 (Jeremy Pierce)
Member id
UHC-58693-80
Confidence
1
Method
probabilistic
MBR-020129CLM-432571
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009375
Orphan claim re-pointed
Claims processor
CLM-424494 → UHC-68274-91 (Ryan Ramirez)
Member id
UHC-68274-91
Confidence
1
Method
probabilistic
MBR-004762CLM-424494
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009376
Orphan claim re-pointed
Claims processor
CLM-427262 → UHC-26724-61 (John Freeman)
Member id
UHC-26724-61
Confidence
0.94
Method
probabilistic
MBR-032082CLM-427262
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009377
Orphan claim re-pointed
Claims processor
CLM-424497 → UHC-20697-04 (Carol Peterson)
Member id
UHC-20697-04
Confidence
1
Method
probabilistic
MBR-004128CLM-424497
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009378
Orphan claim re-pointed
Claims processor
CLM-415557 → UHC-32635-41 (Roy Cole)
Member id
UHC-32635-41
Confidence
1
Method
probabilistic
MBR-017844CLM-415557
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009379
Orphan claim re-pointed
Claims processor
CLM-402398 → UHC-65211-83 (Beth Jimenez)
Member id
UHC-65211-83
Confidence
0.93
Method
probabilistic
MBR-018216CLM-402398
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009380
Orphan claim re-pointed
Claims processor
CLM-413740 → UHC-51134-40 (Bryan Ferguson)
Member id
UHC-51134-40
Confidence
1
Method
probabilistic
MBR-023502CLM-413740
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009381
Orphan claim re-pointed
Claims processor
CLM-401748 → UHC-94405-06 (James Wang)
Member id
UHC-94405-06
Confidence
0.97
Method
deterministic
MBR-011987CLM-401748
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009382
Orphan claim re-pointed
Claims processor
CLM-409175 → UHC-93786-89 (Barbara Ruiz)
Member id
UHC-93786-89
Confidence
0.93
Method
probabilistic
MBR-020782CLM-409175
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009383
Orphan claim re-pointed
Claims processor
CLM-424629 → UHC-46867-34 (Ann Ferguson)
Member id
UHC-46867-34
Confidence
1
Method
probabilistic
MBR-008555CLM-424629
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009384
Orphan claim re-pointed
Claims processor
CLM-411907 → UHC-49757-35 (Jonathan Harris)
Member id
UHC-49757-35
Confidence
1
Method
probabilistic
MBR-025209CLM-411907
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009385
Orphan claim re-pointed
Claims processor
CLM-412007 → UHC-57532-94 (Julia Cook)
Member id
UHC-57532-94
Confidence
1
Method
probabilistic
MBR-005790CLM-412007
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009386
Orphan claim re-pointed
Claims processor
CLM-428502 → UHC-44964-12 (Kimberly Howard)
Member id
UHC-44964-12
Confidence
0.97
Method
deterministic
MBR-025900CLM-428502
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009387
Orphan claim re-pointed
Claims processor
CLM-405479 → UHC-62597-73 (Mei Watkins)
Member id
UHC-62597-73
Confidence
1
Method
probabilistic
MBR-015192CLM-405479
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009388
Orphan claim re-pointed
Claims processor
CLM-402009 → UHC-28147-69 (Julia Banks)
Member id
UHC-28147-69
Confidence
1
Method
probabilistic
MBR-037019CLM-402009
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009389
Orphan claim re-pointed
Claims processor
CLM-420538 → UHC-55090-52 (Marcus Burton)
Member id
UHC-55090-52
Confidence
1
Method
probabilistic
MBR-001654CLM-420538
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 161 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.