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-001512
Orphan claim re-pointed
Claims processor
CLM-418422 → UHC-78519-23 (Joseph Vargas)
Member id
UHC-78519-23
Confidence
1
Method
probabilistic
MBR-036682CLM-418422
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001513
Orphan claim re-pointed
Claims processor
CLM-425536 → UHC-32494-13 (Beverly Cunningham)
Member id
UHC-32494-13
Confidence
1
Method
probabilistic
MBR-015646CLM-425536
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001514
Orphan claim re-pointed
Claims processor
CLM-428690 → UHC-92720-51 (Lucia Rios)
Member id
UHC-92720-51
Confidence
1
Method
probabilistic
MBR-006680CLM-428690
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001515
Orphan claim re-pointed
Claims processor
CLM-417737 → UHC-05335-91 (Wayne Castro)
Member id
UHC-05335-91
Confidence
1
Method
probabilistic
MBR-009948CLM-417737
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001516
Orphan claim re-pointed
Claims processor
CLM-422239 → UHC-37143-79 (Ruth Olson)
Member id
UHC-37143-79
Confidence
1
Method
probabilistic
MBR-000699CLM-422239
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001517
Orphan claim re-pointed
Claims processor
CLM-407065 → UHC-29827-19 (Brenda Wells)
Member id
UHC-29827-19
Confidence
0.97
Method
deterministic
MBR-022624CLM-407065
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001518
Orphan claim re-pointed
Claims processor
CLM-408956 → UHC-45950-02 (Andrea Carroll)
Member id
UHC-45950-02
Confidence
1
Method
probabilistic
MBR-024646CLM-408956
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001519
Orphan claim re-pointed
Claims processor
CLM-400771 → UHC-08091-97 (Angela Yang)
Member id
UHC-08091-97
Confidence
1
Method
probabilistic
MBR-001459CLM-400771
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001520
Orphan claim re-pointed
Claims processor
CLM-413032 → UHC-42291-53 (Brittany Lucas)
Member id
UHC-42291-53
Confidence
1
Method
probabilistic
MBR-006797CLM-413032
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001521
Orphan claim re-pointed
Claims processor
CLM-412305 → UHC-46510-63 (Sharon Davis)
Member id
UHC-46510-63
Confidence
0.93
Method
probabilistic
MBR-002097CLM-412305
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001522
Orphan claim re-pointed
Claims processor
CLM-420448 → UHC-93836-29 (Patrick Boyd)
Member id
UHC-93836-29
Confidence
1
Method
probabilistic
MBR-001790CLM-420448
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001523
Orphan claim re-pointed
Claims processor
CLM-412093 → UHC-85481-64 (Billy Miller)
Member id
UHC-85481-64
Confidence
0.91
Method
probabilistic
MBR-011765CLM-412093
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001524
Orphan claim re-pointed
Claims processor
CLM-408379 → UHC-10242-73 (Ralph Graham)
Member id
UHC-10242-73
Confidence
1
Method
probabilistic
MBR-000817CLM-408379
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001525
Orphan claim re-pointed
Claims processor
CLM-411624 → UHC-52847-57 (George Day)
Member id
UHC-52847-57
Confidence
1
Method
probabilistic
MBR-036396CLM-411624
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001526
Orphan claim re-pointed
Claims processor
CLM-404275 → UHC-75366-47 (Andrea Medina)
Member id
UHC-75366-47
Confidence
1
Method
probabilistic
MBR-033426CLM-404275
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001527
Orphan claim re-pointed
Claims processor
CLM-400183 → UHC-36965-72 (Anthony Ross)
Member id
UHC-36965-72
Confidence
1
Method
probabilistic
MBR-037090CLM-400183
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001528
Orphan claim re-pointed
Claims processor
CLM-413114 → UHC-12538-47 (Carol Fowler)
Member id
UHC-12538-47
Confidence
1
Method
probabilistic
MBR-018557CLM-413114
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001529
Orphan claim re-pointed
Claims processor
CLM-425087 → UHC-27960-11 (Joan Bennett)
Member id
UHC-27960-11
Confidence
1
Method
probabilistic
MBR-010174CLM-425087
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001530
Orphan claim re-pointed
Claims processor
CLM-408137 → UHC-72343-79 (Joseph Scott)
Member id
UHC-72343-79
Confidence
1
Method
probabilistic
MBR-021986CLM-408137
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001531
Orphan claim re-pointed
Claims processor
CLM-404882 → UHC-28782-70 (Kayla Williamson)
Member id
UHC-28782-70
Confidence
1
Method
probabilistic
MBR-005574CLM-404882
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001532
Orphan claim re-pointed
Claims processor
CLM-425985 → UHC-06168-30 (Michelle Jimenez)
Member id
UHC-06168-30
Confidence
1
Method
probabilistic
MBR-014439CLM-425985
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001533
Orphan claim re-pointed
Claims processor
CLM-415984 → UHC-93362-68 (Yuki Porter)
Member id
UHC-93362-68
Confidence
1
Method
probabilistic
MBR-015291CLM-415984
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001534
Orphan claim re-pointed
Claims processor
CLM-415146 → UHC-43837-44 (Carol Ramirez)
Member id
UHC-43837-44
Confidence
1
Method
probabilistic
MBR-002454CLM-415146
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001535
Orphan claim re-pointed
Claims processor
CLM-412307 → UHC-19050-02 (Isabella Black)
Member id
UHC-19050-02
Confidence
1
Method
probabilistic
MBR-041536CLM-412307
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001536
Orphan claim re-pointed
Claims processor
CLM-429977 → UHC-33868-33 (Jacob Jordan)
Member id
UHC-33868-33
Confidence
1
Method
probabilistic
MBR-017144CLM-429977
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001537
Orphan claim re-pointed
Claims processor
CLM-414118 → UHC-48894-38 (Dennis Spencer)
Member id
UHC-48894-38
Confidence
0.97
Method
deterministic
MBR-000087CLM-414118
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001538
Orphan claim re-pointed
Claims processor
CLM-410486 → UHC-98537-14 (Carolyn Price)
Member id
UHC-98537-14
Confidence
1.00
Method
probabilistic
MBR-004876CLM-410486
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001539
Orphan claim re-pointed
Claims processor
CLM-409757 → UHC-61672-34 (Aaron Lee)
Member id
UHC-61672-34
Confidence
1
Method
probabilistic
MBR-009884CLM-409757
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001540
Orphan claim re-pointed
Claims processor
CLM-403638 → UHC-81471-19 (Nicole Wood)
Member id
UHC-81471-19
Confidence
1
Method
probabilistic
MBR-002023CLM-403638
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001541
Orphan claim re-pointed
Claims processor
CLM-400900 → UHC-70464-74 (Gary Valdez)
Member id
UHC-70464-74
Confidence
0.97
Method
deterministic
MBR-028237CLM-400900
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001542
Orphan claim re-pointed
Claims processor
CLM-407428 → UHC-30601-68 (Kenneth Chavez)
Member id
UHC-30601-68
Confidence
0.97
Method
deterministic
MBR-027230CLM-407428
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001543
Orphan claim re-pointed
Claims processor
CLM-420564 → UHC-97571-27 (Vincent Gutierrez)
Member id
UHC-97571-27
Confidence
0.97
Method
deterministic
MBR-042736CLM-420564
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001544
Orphan claim re-pointed
Claims processor
CLM-401879 → UHC-51254-08 (Patricia Wood)
Member id
UHC-51254-08
Confidence
1
Method
probabilistic
MBR-027385CLM-401879
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001545
Orphan claim re-pointed
Claims processor
CLM-415177 → UHC-59069-95 (Peter Alexander)
Member id
UHC-59069-95
Confidence
0.97
Method
deterministic
MBR-003936CLM-415177
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001546
Orphan claim re-pointed
Claims processor
CLM-426668 → UHC-71604-82 (Ana Lee)
Member id
UHC-71604-82
Confidence
1
Method
probabilistic
MBR-031901CLM-426668
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001547
Orphan claim re-pointed
Claims processor
CLM-419683 → UHC-04711-59 (Dorothy Lawrence)
Member id
UHC-04711-59
Confidence
1
Method
probabilistic
MBR-015146CLM-419683
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001548
Orphan claim re-pointed
Claims processor
CLM-428229 → UHC-42145-76 (Bryan Foster)
Member id
UHC-42145-76
Confidence
1
Method
probabilistic
MBR-003172CLM-428229
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001549
Orphan claim re-pointed
Claims processor
CLM-413005 → UHC-73108-23 (Lauren Valdez)
Member id
UHC-73108-23
Confidence
0.97
Method
deterministic
MBR-040989CLM-413005
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001550
Orphan claim re-pointed
Claims processor
CLM-400811 → UHC-21934-36 (Brandon Russell)
Member id
UHC-21934-36
Confidence
0.97
Method
deterministic
MBR-019074CLM-400811
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001551
Orphan claim re-pointed
Claims processor
CLM-423257 → UHC-59331-75 (Mark Howell)
Member id
UHC-59331-75
Confidence
0.97
Method
deterministic
MBR-005541CLM-423257
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001552
Orphan claim re-pointed
Claims processor
CLM-429918 → UHC-95888-71 (Ana McCoy)
Member id
UHC-95888-71
Confidence
0.97
Method
deterministic
MBR-039127CLM-429918
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001553
Orphan claim re-pointed
Claims processor
CLM-401105 → UHC-16502-55 (Sara James)
Member id
UHC-16502-55
Confidence
0.98
Method
probabilistic
MBR-013161CLM-401105
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001554
Orphan claim re-pointed
Claims processor
CLM-422049 → UHC-73484-68 (Eric Hall)
Member id
UHC-73484-68
Confidence
0.98
Method
probabilistic
MBR-022895CLM-422049
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001555
Orphan claim re-pointed
Claims processor
CLM-416581 → UHC-04462-47 (Mason Ramirez)
Member id
UHC-04462-47
Confidence
0.99
Method
probabilistic
MBR-001938CLM-416581
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001556
Orphan claim re-pointed
Claims processor
CLM-407577 → UHC-14958-17 (Mateo Salazar)
Member id
UHC-14958-17
Confidence
1
Method
probabilistic
MBR-029474CLM-407577
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001557
Orphan claim re-pointed
Claims processor
CLM-415988 → UHC-34995-40 (Teresa Reyes)
Member id
UHC-34995-40
Confidence
1
Method
probabilistic
MBR-040347CLM-415988
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001558
Orphan claim re-pointed
Claims processor
CLM-420748 → UHC-05632-94 (Walter Hernandez)
Member id
UHC-05632-94
Confidence
0.97
Method
deterministic
MBR-007723CLM-420748
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001559
Orphan claim re-pointed
Claims processor
CLM-408990 → UHC-64589-54 (Ashley Hansen)
Member id
UHC-64589-54
Confidence
1
Method
probabilistic
MBR-000594CLM-408990
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001560
Orphan claim re-pointed
Claims processor
CLM-416312 → UHC-78882-41 (Kathleen Johnston)
Member id
UHC-78882-41
Confidence
0.97
Method
deterministic
MBR-009752CLM-416312
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001561
Orphan claim re-pointed
Claims processor
CLM-405233 → UHC-52836-55 (Victoria Hawkins)
Member id
UHC-52836-55
Confidence
0.97
Method
deterministic
MBR-018388CLM-405233
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 169 of 533PreviousNext

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.