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-009840
Orphan claim re-pointed
Claims processor
CLM-415192 → UHC-25116-10 (Arthur Morgan)
Member id
UHC-25116-10
Confidence
1
Method
probabilistic
MBR-024713CLM-415192
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009841
Orphan claim re-pointed
Claims processor
CLM-406016 → UHC-32609-65 (Deborah Riley)
Member id
UHC-32609-65
Confidence
1
Method
probabilistic
MBR-004683CLM-406016
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009842
Orphan claim re-pointed
Claims processor
CLM-426645 → UHC-22256-78 (Teresa Park)
Member id
UHC-22256-78
Confidence
0.97
Method
deterministic
MBR-012835CLM-426645
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009843
Orphan claim re-pointed
Claims processor
CLM-409466 → UHC-82176-57 (Wayne Diez)
Member id
UHC-82176-57
Confidence
0.98
Method
probabilistic
MBR-029394CLM-409466
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009844
Orphan claim re-pointed
Claims processor
CLM-424471 → UHC-86329-56 (Gerald Olson)
Member id
UHC-86329-56
Confidence
1
Method
probabilistic
MBR-007438CLM-424471
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009845
Orphan claim re-pointed
Claims processor
CLM-410891 → UHC-91757-89 (Katherine Bell)
Member id
UHC-91757-89
Confidence
1
Method
probabilistic
MBR-026521CLM-410891
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009846
Orphan claim re-pointed
Claims processor
CLM-414948 → UHC-68184-37 (Randy Singh)
Member id
UHC-68184-37
Confidence
0.86
Method
probabilistic
MBR-029466CLM-414948
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009847
Orphan claim re-pointed
Claims processor
CLM-429457 → UHC-11839-77 (Harold Barnes)
Member id
UHC-11839-77
Confidence
0.94
Method
probabilistic
MBR-006130CLM-429457
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009848
Orphan claim re-pointed
Claims processor
CLM-406541 → UHC-80241-67 (Walter Phillips)
Member id
UHC-80241-67
Confidence
1
Method
probabilistic
MBR-008933CLM-406541
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009849
Orphan claim re-pointed
Claims processor
CLM-411228 → UHC-00788-94 (Jacob Vasquez)
Member id
UHC-00788-94
Confidence
0.97
Method
deterministic
MBR-021300CLM-411228
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009850
Orphan claim re-pointed
Claims processor
CLM-432725 → UHC-88260-03 (Ana Adams)
Member id
UHC-88260-03
Confidence
1
Method
probabilistic
MBR-003292CLM-432725
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009851
Orphan claim re-pointed
Claims processor
CLM-407461 → UHC-46515-10 (Carolyn Palmer)
Member id
UHC-46515-10
Confidence
1
Method
probabilistic
MBR-025234CLM-407461
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009852
Orphan claim re-pointed
Claims processor
CLM-428558 → UHC-17373-66 (Natalie Phillips)
Member id
UHC-17373-66
Confidence
0.97
Method
deterministic
MBR-037802CLM-428558
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009853
Orphan claim re-pointed
Claims processor
CLM-407918 → UHC-28103-90 (Debra Price)
Member id
UHC-28103-90
Confidence
1
Method
probabilistic
MBR-017866CLM-407918
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009854
Orphan claim re-pointed
Claims processor
CLM-409407 → UHC-98890-36 (Mason Munoz)
Member id
UHC-98890-36
Confidence
1
Method
probabilistic
MBR-018332CLM-409407
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009855
Orphan claim re-pointed
Claims processor
CLM-423091 → UHC-11916-11 (Amber Watkins)
Member id
UHC-11916-11
Confidence
1
Method
probabilistic
MBR-009897CLM-423091
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009856
Orphan claim re-pointed
Claims processor
CLM-415846 → UHC-87921-34 (Kayla Simmons)
Member id
UHC-87921-34
Confidence
1
Method
probabilistic
MBR-020387CLM-415846
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009857
Orphan claim re-pointed
Claims processor
CLM-431080 → UHC-96916-94 (Mei Vega)
Member id
UHC-96916-94
Confidence
0.97
Method
deterministic
MBR-019204CLM-431080
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009858
Orphan claim re-pointed
Claims processor
CLM-404244 → UHC-31003-23 (Matthew Carroll)
Member id
UHC-31003-23
Confidence
0.99
Method
probabilistic
MBR-035047CLM-404244
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009859
Orphan claim re-pointed
Claims processor
CLM-411837 → UHC-67677-60 (Sarah Nguyen)
Member id
UHC-67677-60
Confidence
1
Method
probabilistic
MBR-003899CLM-411837
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009860
Orphan claim re-pointed
Claims processor
CLM-416680 → UHC-27472-49 (Dorothy Wagner)
Member id
UHC-27472-49
Confidence
1
Method
probabilistic
MBR-001127CLM-416680
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009861
Orphan claim re-pointed
Claims processor
CLM-420184 → UHC-60924-40 (Brenda Clark)
Member id
UHC-60924-40
Confidence
1
Method
probabilistic
MBR-005181CLM-420184
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009862
Orphan claim re-pointed
Claims processor
CLM-405662 → UHC-75741-56 (Brenda Bennett)
Member id
UHC-75741-56
Confidence
1
Method
probabilistic
MBR-017760CLM-405662
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009863
Orphan claim re-pointed
Claims processor
CLM-423213 → UHC-90829-10 (Andrea Stewart)
Member id
UHC-90829-10
Confidence
1
Method
probabilistic
MBR-028566CLM-423213
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009864
Orphan claim re-pointed
Claims processor
CLM-417169 → UHC-83297-25 (Nicholas Rodriguez)
Member id
UHC-83297-25
Confidence
0.97
Method
deterministic
MBR-011941CLM-417169
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009865
Orphan claim re-pointed
Claims processor
CLM-403947 → UHC-69417-14 (Ralph Garza)
Member id
UHC-69417-14
Confidence
1
Method
probabilistic
MBR-039721CLM-403947
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009866
Orphan claim re-pointed
Claims processor
CLM-407717 → UHC-04228-65 (Ann Murray)
Member id
UHC-04228-65
Confidence
0.97
Method
deterministic
MBR-000797CLM-407717
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009867
Orphan claim re-pointed
Claims processor
CLM-427647 → UHC-41265-38 (Sofia Arnold)
Member id
UHC-41265-38
Confidence
1
Method
probabilistic
MBR-020867CLM-427647
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009868
Orphan claim re-pointed
Claims processor
CLM-404996 → UHC-63573-13 (Bruce Bowman)
Member id
UHC-63573-13
Confidence
1
Method
probabilistic
MBR-009343CLM-404996
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009869
Orphan claim re-pointed
Claims processor
CLM-430551 → UHC-18319-88 (Alexander Lawrence)
Member id
UHC-18319-88
Confidence
1
Method
probabilistic
MBR-030479CLM-430551
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009870
Orphan claim re-pointed
Claims processor
CLM-417966 → UHC-92206-23 (Sofia Ramirez)
Member id
UHC-92206-23
Confidence
1
Method
probabilistic
MBR-023835CLM-417966
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009871
Orphan claim re-pointed
Claims processor
CLM-420671 → UHC-76703-06 (Russell Hart)
Member id
UHC-76703-06
Confidence
1
Method
probabilistic
MBR-037537CLM-420671
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009872
Orphan claim re-pointed
Claims processor
CLM-412517 → UHC-33554-79 (Kathleen Munoz)
Member id
UHC-33554-79
Confidence
0.97
Method
deterministic
MBR-020928CLM-412517
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009873
Orphan claim re-pointed
Claims processor
CLM-422631 → UHC-17270-31 (Thomas Hicks)
Member id
UHC-17270-31
Confidence
0.97
Method
deterministic
MBR-020623CLM-422631
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009874
Orphan claim re-pointed
Claims processor
CLM-415624 → UHC-45899-75 (Donna Weaver)
Member id
UHC-45899-75
Confidence
0.97
Method
deterministic
MBR-009021CLM-415624
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009875
Orphan claim re-pointed
Claims processor
CLM-413146 → UHC-89695-64 (Ann McCoy)
Member id
UHC-89695-64
Confidence
1
Method
probabilistic
MBR-012828CLM-413146
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009876
Orphan claim re-pointed
Claims processor
CLM-408112 → UHC-56346-66 (Pamela Jackson)
Member id
UHC-56346-66
Confidence
0.97
Method
deterministic
MBR-033990CLM-408112
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009877
Orphan claim re-pointed
Claims processor
CLM-426816 → UHC-17778-93 (Stephanie Ward)
Member id
UHC-17778-93
Confidence
0.99
Method
probabilistic
MBR-008000CLM-426816
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009878
Orphan claim re-pointed
Claims processor
CLM-425409 → UHC-57765-55 (Kelly Herrera)
Member id
UHC-57765-55
Confidence
1
Method
probabilistic
MBR-025064CLM-425409
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009879
Orphan claim re-pointed
Claims processor
CLM-408845 → UHC-76478-80 (Aaron Andrews)
Member id
UHC-76478-80
Confidence
1
Method
probabilistic
MBR-029226CLM-408845
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009880
Orphan claim re-pointed
Claims processor
CLM-413278 → UHC-59861-38 (Katherne King)
Member id
UHC-59861-38
Confidence
1.00
Method
probabilistic
MBR-002485CLM-413278
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009881
Orphan claim re-pointed
Claims processor
CLM-430089 → UHC-90833-77 (Albert Thompson)
Member id
UHC-90833-77
Confidence
0.97
Method
deterministic
MBR-045426CLM-430089
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009882
Orphan claim re-pointed
Claims processor
CLM-418987 → UHC-07701-06 (Ahmed Sanders)
Member id
UHC-07701-06
Confidence
1
Method
probabilistic
MBR-017329CLM-418987
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009883
Orphan claim re-pointed
Claims processor
CLM-423085 → UHC-00835-26 (Ana Knight)
Member id
UHC-00835-26
Confidence
1
Method
probabilistic
MBR-027941CLM-423085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009884
Orphan claim re-pointed
Claims processor
CLM-422389 → UHC-11754-06 (Carolyn McCcoy)
Member id
UHC-11754-06
Confidence
0.92
Method
probabilistic
MBR-009905CLM-422389
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009885
Orphan claim re-pointed
Claims processor
CLM-418455 → UHC-61001-47 (Lawrence Morris)
Member id
UHC-61001-47
Confidence
1
Method
probabilistic
MBR-011104CLM-418455
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009886
Orphan claim re-pointed
Claims processor
CLM-424095 → UHC-37073-66 (Nicole Gonzalez)
Member id
UHC-37073-66
Confidence
1
Method
probabilistic
MBR-003217CLM-424095
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009887
Orphan claim re-pointed
Claims processor
CLM-417980 → UHC-61124-09 (Scott Scott)
Member id
UHC-61124-09
Confidence
1
Method
probabilistic
MBR-001912CLM-417980
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009888
Orphan claim re-pointed
Claims processor
CLM-415909 → UHC-91345-99 (Alexis Reynolds)
Member id
UHC-91345-99
Confidence
1
Method
probabilistic
MBR-022108CLM-415909
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009889
Orphan claim re-pointed
Claims processor
CLM-401732 → UHC-21221-38 (Priya Bryant)
Member id
UHC-21221-38
Confidence
1
Method
probabilistic
MBR-021734CLM-401732
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 171 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.