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-009740
Orphan claim re-pointed
Claims processor
CLM-429761 → UHC-97923-15 (Nicole Le)
Member id
UHC-97923-15
Confidence
0.89
Method
probabilistic
MBR-020070CLM-429761
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009741
Orphan claim re-pointed
Claims processor
CLM-408741 → UHC-63134-98 (Alice Tran)
Member id
UHC-63134-98
Confidence
0.97
Method
deterministic
MBR-009194CLM-408741
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009742
Orphan claim re-pointed
Claims processor
CLM-429299 → UHC-18016-81 (Arthur Smith)
Member id
UHC-18016-81
Confidence
1
Method
probabilistic
MBR-002841CLM-429299
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009743
Orphan claim re-pointed
Claims processor
CLM-418670 → UHC-78816-20 (Jack Clark)
Member id
UHC-78816-20
Confidence
1
Method
probabilistic
MBR-012689CLM-418670
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009744
Orphan claim re-pointed
Claims processor
CLM-420645 → UHC-29663-24 (Adam Campbell)
Member id
UHC-29663-24
Confidence
1
Method
probabilistic
MBR-031845CLM-420645
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009745
Orphan claim re-pointed
Claims processor
CLM-428397 → UHC-47295-78 (Paul Vega)
Member id
UHC-47295-78
Confidence
0.97
Method
deterministic
MBR-020174CLM-428397
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009746
Orphan claim re-pointed
Claims processor
CLM-408181 → UHC-19783-63 (Alice Wang)
Member id
UHC-19783-63
Confidence
1
Method
probabilistic
MBR-011058CLM-408181
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009747
Orphan claim re-pointed
Claims processor
CLM-411092 → UHC-82957-73 (Luis Garcia)
Member id
UHC-82957-73
Confidence
1
Method
probabilistic
MBR-012889CLM-411092
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009748
Orphan claim re-pointed
Claims processor
CLM-411562 → UHC-96174-01 (Valentina Mejia)
Member id
UHC-96174-01
Confidence
1
Method
probabilistic
MBR-043463CLM-411562
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009749
Orphan claim re-pointed
Claims processor
CLM-415104 → UHC-98397-43 (Ralph Oliver)
Member id
UHC-98397-43
Confidence
0.99
Method
probabilistic
MBR-010577CLM-415104
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009750
Orphan claim re-pointed
Claims processor
CLM-429016 → UHC-46437-60 (Brenda Green)
Member id
UHC-46437-60
Confidence
1
Method
probabilistic
MBR-011069CLM-429016
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009751
Orphan claim re-pointed
Claims processor
CLM-422107 → UHC-46336-83 (Olivia Davis)
Member id
UHC-46336-83
Confidence
0.93
Method
probabilistic
MBR-003808CLM-422107
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009752
Orphan claim re-pointed
Claims processor
CLM-401055 → UHC-79809-95 (Sophia Henry)
Member id
UHC-79809-95
Confidence
0.97
Method
deterministic
MBR-038069CLM-401055
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009753
Orphan claim re-pointed
Claims processor
CLM-405035 → UHC-07597-48 (Carlos Young)
Member id
UHC-07597-48
Confidence
0.94
Method
probabilistic
MBR-035139CLM-405035
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009754
Orphan claim re-pointed
Claims processor
CLM-401440 → UHC-59211-88 (Bruce Chavez)
Member id
UHC-59211-88
Confidence
1
Method
probabilistic
MBR-002881CLM-401440
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009755
Orphan claim re-pointed
Claims processor
CLM-402833 → UHC-33757-50 (Martha Chapman)
Member id
UHC-33757-50
Confidence
1
Method
probabilistic
MBR-034119CLM-402833
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009756
Orphan claim re-pointed
Claims processor
CLM-416639 → UHC-43941-81 (Ralph Ruiz)
Member id
UHC-43941-81
Confidence
1
Method
probabilistic
MBR-017033CLM-416639
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009757
Orphan claim re-pointed
Claims processor
CLM-403603 → UHC-46761-66 (Peter Rose)
Member id
UHC-46761-66
Confidence
1
Method
probabilistic
MBR-014741CLM-403603
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009758
Orphan claim re-pointed
Claims processor
CLM-407256 → UHC-64736-32 (Jonathan Coleman)
Member id
UHC-64736-32
Confidence
1
Method
probabilistic
MBR-004998CLM-407256
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009759
Orphan claim re-pointed
Claims processor
CLM-420003 → UHC-44942-90 (Ann Bishop)
Member id
UHC-44942-90
Confidence
0.97
Method
deterministic
MBR-001025CLM-420003
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009760
Orphan claim re-pointed
Claims processor
CLM-417635 → UHC-05308-73 (Jones Brian)
Member id
UHC-05308-73
Confidence
0.98
Method
probabilistic
MBR-023461CLM-417635
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009761
Orphan claim re-pointed
Claims processor
CLM-413363 → UHC-09140-27 (Anrew Ramos)
Member id
UHC-09140-27
Confidence
0.97
Method
deterministic
MBR-031561CLM-413363
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009762
Orphan claim re-pointed
Claims processor
CLM-411372 → UHC-22840-88 (Peter Edwards)
Member id
UHC-22840-88
Confidence
1
Method
probabilistic
MBR-033233CLM-411372
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009763
Orphan claim re-pointed
Claims processor
CLM-418471 → UHC-54920-73 (Madison McCoy)
Member id
UHC-54920-73
Confidence
1
Method
probabilistic
MBR-022389CLM-418471
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009764
Orphan claim re-pointed
Claims processor
CLM-422680 → UHC-89770-54 (Kathryn Berry)
Member id
UHC-89770-54
Confidence
1
Method
probabilistic
MBR-005015CLM-422680
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009765
Orphan claim re-pointed
Claims processor
CLM-432757 → UHC-84285-56 (Adam Williamson)
Member id
UHC-84285-56
Confidence
1
Method
probabilistic
MBR-004673CLM-432757
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009766
Orphan claim re-pointed
Claims processor
CLM-409341 → UHC-25318-23 (Fatima Coleman)
Member id
UHC-25318-23
Confidence
0.97
Method
deterministic
MBR-042723CLM-409341
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009767
Orphan claim re-pointed
Claims processor
CLM-423668 → UHC-98266-18 (Santiago Price)
Member id
UHC-98266-18
Confidence
0.99
Method
probabilistic
MBR-036870CLM-423668
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009768
Orphan claim re-pointed
Claims processor
CLM-404675 → UHC-87798-97 (Sophia Hill)
Member id
UHC-87798-97
Confidence
1
Method
probabilistic
MBR-002649CLM-404675
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009769
Orphan claim re-pointed
Claims processor
CLM-420665 → UHC-17753-40 (Scott Thomas)
Member id
UHC-17753-40
Confidence
1
Method
probabilistic
MBR-002585CLM-420665
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009770
Orphan claim re-pointed
Claims processor
CLM-429437 → UHC-74169-30 (Jerry Morrison)
Member id
UHC-74169-30
Confidence
1
Method
probabilistic
MBR-032269CLM-429437
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009771
Orphan claim re-pointed
Claims processor
CLM-400228 → UHC-87537-12 (Evelyn Knight)
Member id
UHC-87537-12
Confidence
1
Method
probabilistic
MBR-009404CLM-400228
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009772
Orphan claim re-pointed
Claims processor
CLM-406738 → UHC-95909-64 (Barbara Hanson)
Member id
UHC-95909-64
Confidence
1
Method
probabilistic
MBR-024933CLM-406738
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009773
Orphan claim re-pointed
Claims processor
CLM-426120 → UHC-24684-36 (Russell Ruiz)
Member id
UHC-24684-36
Confidence
1
Method
probabilistic
MBR-016141CLM-426120
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009774
Orphan claim re-pointed
Claims processor
CLM-420281 → UHC-99707-79 (Maria Carter)
Member id
UHC-99707-79
Confidence
0.99
Method
probabilistic
MBR-003864CLM-420281
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009775
Orphan claim re-pointed
Claims processor
CLM-420794 → UHC-27291-77 (Diane Lewis)
Member id
UHC-27291-77
Confidence
1
Method
probabilistic
MBR-034970CLM-420794
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009776
Orphan claim re-pointed
Claims processor
CLM-407201 → UHC-71340-83 (Ralph Perry)
Member id
UHC-71340-83
Confidence
1
Method
probabilistic
MBR-035804CLM-407201
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009777
Orphan claim re-pointed
Claims processor
CLM-404265 → UHC-32054-39 (Daniel Evans)
Member id
UHC-32054-39
Confidence
1
Method
probabilistic
MBR-000520CLM-404265
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009778
Orphan claim re-pointed
Claims processor
CLM-428349 → UHC-64195-37 (Frances Berry)
Member id
UHC-64195-37
Confidence
1
Method
probabilistic
MBR-012605CLM-428349
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009779
Orphan claim re-pointed
Claims processor
CLM-408143 → UHC-50023-54 (Henry Reid)
Member id
UHC-50023-54
Confidence
1
Method
probabilistic
MBR-018620CLM-408143
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009780
Orphan claim re-pointed
Claims processor
CLM-408067 → UHC-24246-34 (Christopher Henderson)
Member id
UHC-24246-34
Confidence
1
Method
probabilistic
MBR-015202CLM-408067
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009781
Orphan claim re-pointed
Claims processor
CLM-427485 → UHC-53237-67 (Kimberly Robertson)
Member id
UHC-53237-67
Confidence
1
Method
probabilistic
MBR-024162CLM-427485
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009782
Orphan claim re-pointed
Claims processor
CLM-428652 → UHC-34565-98 (Charles Williams)
Member id
UHC-34565-98
Confidence
1
Method
probabilistic
MBR-027833CLM-428652
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009783
Orphan claim re-pointed
Claims processor
CLM-415700 → UHC-13174-98 (Judy Burns)
Member id
UHC-13174-98
Confidence
1
Method
probabilistic
MBR-007661CLM-415700
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009784
Orphan claim re-pointed
Claims processor
CLM-407579 → UHC-19582-46 (Alice Murphy)
Member id
UHC-19582-46
Confidence
1
Method
probabilistic
MBR-006115CLM-407579
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009785
Orphan claim re-pointed
Claims processor
CLM-416321 → UHC-50247-35 (Gabriel Carr)
Member id
UHC-50247-35
Confidence
1
Method
probabilistic
MBR-019208CLM-416321
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009786
Orphan claim re-pointed
Claims processor
CLM-422200 → UHC-87463-27 (Joyce Reynolds)
Member id
UHC-87463-27
Confidence
1.00
Method
probabilistic
MBR-026034CLM-422200
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009787
Orphan claim re-pointed
Claims processor
CLM-405436 → UHC-56805-86 (Carlos Lopez)
Member id
UHC-56805-86
Confidence
1
Method
probabilistic
MBR-012917CLM-405436
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009788
Orphan claim re-pointed
Claims processor
CLM-422204 → UHC-13209-74 (Aaron Coleman)
Member id
UHC-13209-74
Confidence
1
Method
probabilistic
MBR-030727CLM-422204
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009789
Orphan claim re-pointed
Claims processor
CLM-414845 → UHC-55125-01 (Betty Peters)
Member id
UHC-55125-01
Confidence
1
Method
probabilistic
MBR-020110CLM-414845
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 169 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.