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-001662
Orphan claim re-pointed
Claims processor
CLM-400475 → UHC-71028-83 (Robert Welch)
Member id
UHC-71028-83
Confidence
1
Method
probabilistic
MBR-006106CLM-400475
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001663
Orphan claim re-pointed
Claims processor
CLM-420437 → UHC-47088-25 (Ronald Ellis)
Member id
UHC-47088-25
Confidence
0.97
Method
deterministic
MBR-016763CLM-420437
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001664
Orphan claim re-pointed
Claims processor
CLM-426866 → UHC-68665-03 (Jordan Ferguson)
Member id
UHC-68665-03
Confidence
1
Method
probabilistic
MBR-018358CLM-426866
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001665
Orphan claim re-pointed
Claims processor
CLM-430822 → UHC-99271-57 (Kimberly Wang)
Member id
UHC-99271-57
Confidence
1
Method
probabilistic
MBR-028132CLM-430822
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001666
Orphan claim re-pointed
Claims processor
CLM-426923 → UHC-28733-52 (Sofia Gonzalez)
Member id
UHC-28733-52
Confidence
1
Method
probabilistic
MBR-001440CLM-426923
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001667
Orphan claim re-pointed
Claims processor
CLM-430691 → UHC-69584-36 (Jose Harvey)
Member id
UHC-69584-36
Confidence
1
Method
probabilistic
MBR-035932CLM-430691
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001668
Orphan claim re-pointed
Claims processor
CLM-401190 → UHC-19534-62 (Sofia Yang)
Member id
UHC-19534-62
Confidence
1
Method
probabilistic
MBR-007443CLM-401190
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001669
Orphan claim re-pointed
Claims processor
CLM-400995 → UHC-15801-99 (Jason Garrett)
Member id
UHC-15801-99
Confidence
1
Method
probabilistic
MBR-010493CLM-400995
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001670
Orphan claim re-pointed
Claims processor
CLM-414647 → UHC-46520-40 (Santiago Wong)
Member id
UHC-46520-40
Confidence
0.97
Method
deterministic
MBR-013102CLM-414647
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001671
Orphan claim re-pointed
Claims processor
CLM-429106 → UHC-77898-36 (Anna Murphy)
Member id
UHC-77898-36
Confidence
1
Method
probabilistic
MBR-027298CLM-429106
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001672
Orphan claim re-pointed
Claims processor
CLM-406959 → UHC-06730-30 (Joe Carlson)
Member id
UHC-06730-30
Confidence
0.97
Method
deterministic
MBR-039586CLM-406959
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001673
Orphan claim re-pointed
Claims processor
CLM-431059 → UHC-20299-86 (Jonathan Hunt)
Member id
UHC-20299-86
Confidence
1
Method
probabilistic
MBR-008072CLM-431059
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001674
Orphan claim re-pointed
Claims processor
CLM-420049 → UHC-35222-28 (Alan Pierce)
Member id
UHC-35222-28
Confidence
1
Method
probabilistic
MBR-013887CLM-420049
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001675
Orphan claim re-pointed
Claims processor
CLM-424160 → UHC-17028-42 (Randy Maldonado)
Member id
UHC-17028-42
Confidence
0.99
Method
probabilistic
MBR-019240CLM-424160
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001676
Orphan claim re-pointed
Claims processor
CLM-401783 → UHC-66150-22 (Amy Rice)
Member id
UHC-66150-22
Confidence
0.97
Method
deterministic
MBR-026347CLM-401783
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001677
Orphan claim re-pointed
Claims processor
CLM-415621 → UHC-28164-13 (Ana Walker)
Member id
UHC-28164-13
Confidence
0.97
Method
deterministic
MBR-009654CLM-415621
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001678
Orphan claim re-pointed
Claims processor
CLM-411068 → UHC-70614-01 (Beverly Ryan)
Member id
UHC-70614-01
Confidence
0.97
Method
deterministic
MBR-032871CLM-411068
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001679
Orphan claim re-pointed
Claims processor
CLM-411809 → UHC-83880-59 (Gary Hamilton)
Member id
UHC-83880-59
Confidence
1
Method
probabilistic
MBR-029620CLM-411809
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001680
Orphan claim re-pointed
Claims processor
CLM-431690 → UHC-71794-17 (Jacqueline Richards)
Member id
UHC-71794-17
Confidence
1
Method
probabilistic
MBR-002078CLM-431690
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001681
Orphan claim re-pointed
Claims processor
CLM-430466 → UHC-96542-58 (Joyce Sanders)
Member id
UHC-96542-58
Confidence
0.99
Method
probabilistic
MBR-020368CLM-430466
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001682
Orphan claim re-pointed
Claims processor
CLM-401628 → UHC-49778-27 (Cheryl Arnold)
Member id
UHC-49778-27
Confidence
1
Method
probabilistic
MBR-004892CLM-401628
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001683
Orphan claim re-pointed
Claims processor
CLM-400397 → UHC-89598-42 (Douglas Reyes)
Member id
UHC-89598-42
Confidence
1
Method
probabilistic
MBR-029149CLM-400397
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001684
Orphan claim re-pointed
Claims processor
CLM-420427 → UHC-18931-33 (Thomas Carter)
Member id
UHC-18931-33
Confidence
0.97
Method
deterministic
MBR-005273CLM-420427
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001685
Orphan claim re-pointed
Claims processor
CLM-427051 → UHC-14951-40 (Isabella Singh)
Member id
UHC-14951-40
Confidence
1
Method
probabilistic
MBR-028304CLM-427051
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001686
Orphan claim re-pointed
Claims processor
CLM-418982 → UHC-50033-62 (Gary Jordan)
Member id
UHC-50033-62
Confidence
1
Method
probabilistic
MBR-007801CLM-418982
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001687
Orphan claim re-pointed
Claims processor
CLM-431503 → UHC-12386-49 (Martha Harvey)
Member id
UHC-12386-49
Confidence
1
Method
probabilistic
MBR-004236CLM-431503
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001688
Orphan claim re-pointed
Claims processor
CLM-407638 → UHC-43455-67 (Ana Mason)
Member id
UHC-43455-67
Confidence
1
Method
probabilistic
MBR-006128CLM-407638
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001689
Orphan claim re-pointed
Claims processor
CLM-432237 → UHC-42112-04 (Carl West)
Member id
UHC-42112-04
Confidence
1
Method
probabilistic
MBR-025601CLM-432237
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001690
Orphan claim re-pointed
Claims processor
CLM-431801 → UHC-68365-96 (Ann Alvarado)
Member id
UHC-68365-96
Confidence
1
Method
probabilistic
MBR-023244CLM-431801
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001691
Orphan claim re-pointed
Claims processor
CLM-410388 → UHC-20902-98 (Jeremy Cook)
Member id
UHC-20902-98
Confidence
0.97
Method
deterministic
MBR-012010CLM-410388
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001692
Orphan claim re-pointed
Claims processor
CLM-424061 → UHC-10104-58 (Luis Jones)
Member id
UHC-10104-58
Confidence
0.97
Method
deterministic
MBR-022603CLM-424061
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001693
Orphan claim re-pointed
Claims processor
CLM-413004 → UHC-54709-71 (Mateo Barnes)
Member id
UHC-54709-71
Confidence
1
Method
probabilistic
MBR-012219CLM-413004
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001694
Orphan claim re-pointed
Claims processor
CLM-427949 → UHC-54097-94 (Lauren Howard)
Member id
UHC-54097-94
Confidence
1
Method
probabilistic
MBR-031234CLM-427949
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001695
Orphan claim re-pointed
Claims processor
CLM-429625 → UHC-46672-95 (Sue Williams)
Member id
UHC-46672-95
Confidence
0.97
Method
deterministic
MBR-002070CLM-429625
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001696
Orphan claim re-pointed
Claims processor
CLM-427534 → UHC-81174-40 (Christian Meyer)
Member id
UHC-81174-40
Confidence
1
Method
probabilistic
MBR-008776CLM-427534
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001697
Orphan claim re-pointed
Claims processor
CLM-410267 → UHC-53781-65 (Michael Evans)
Member id
UHC-53781-65
Confidence
0.97
Method
deterministic
MBR-031146CLM-410267
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001698
Orphan claim re-pointed
Claims processor
CLM-424532 → UHC-44026-65 (Bryan Hanson)
Member id
UHC-44026-65
Confidence
1
Method
probabilistic
MBR-011504CLM-424532
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001699
Orphan claim re-pointed
Claims processor
CLM-409805 → UHC-36731-44 (Dennis Greene)
Member id
UHC-36731-44
Confidence
1
Method
probabilistic
MBR-030963CLM-409805
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001700
Orphan claim re-pointed
Claims processor
CLM-429840 → UHC-94950-75 (Lauren Ramos)
Member id
UHC-94950-75
Confidence
1
Method
probabilistic
MBR-040551CLM-429840
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001701
Orphan claim re-pointed
Claims processor
CLM-424103 → UHC-36356-27 (Edward George)
Member id
UHC-36356-27
Confidence
0.97
Method
deterministic
MBR-004829CLM-424103
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001702
Orphan claim re-pointed
Claims processor
CLM-415835 → UHC-98476-18 (Kenneth Thompson)
Member id
UHC-98476-18
Confidence
1
Method
probabilistic
MBR-023075CLM-415835
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001703
Orphan claim re-pointed
Claims processor
CLM-408785 → UHC-27250-83 (Santiago Moore)
Member id
UHC-27250-83
Confidence
1
Method
probabilistic
MBR-014232CLM-408785
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001704
Orphan claim re-pointed
Claims processor
CLM-410955 → UHC-53705-72 (Noah Roberts)
Member id
UHC-53705-72
Confidence
1
Method
probabilistic
MBR-016768CLM-410955
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001705
Orphan claim re-pointed
Claims processor
CLM-418555 → UHC-31222-94 (Sara Owens)
Member id
UHC-31222-94
Confidence
1
Method
probabilistic
MBR-002276CLM-418555
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001706
Orphan claim re-pointed
Claims processor
CLM-405959 → UHC-16884-13 (David Padilla)
Member id
UHC-16884-13
Confidence
1
Method
probabilistic
MBR-013557CLM-405959
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001707
Orphan claim re-pointed
Claims processor
CLM-411066 → UHC-28897-69 (Sandra Morgan)
Member id
UHC-28897-69
Confidence
1
Method
probabilistic
MBR-023034CLM-411066
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001708
Orphan claim re-pointed
Claims processor
CLM-401734 → UHC-27338-25 (Kyle Schultz)
Member id
UHC-27338-25
Confidence
0.93
Method
probabilistic
MBR-038855CLM-401734
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001709
Orphan claim re-pointed
Claims processor
CLM-423214 → UHC-27580-31 (Ana Nunez)
Member id
UHC-27580-31
Confidence
1
Method
probabilistic
MBR-000901CLM-423214
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001710
Orphan claim re-pointed
Claims processor
CLM-409816 → UHC-52639-41 (Hiroshi Rice)
Member id
UHC-52639-41
Confidence
0.97
Method
deterministic
MBR-004166CLM-409816
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001711
Orphan claim re-pointed
Claims processor
CLM-411558 → UHC-19513-90 (Gary King)
Member id
UHC-19513-90
Confidence
1
Method
probabilistic
MBR-017229CLM-411558
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 172 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.