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-001762
Orphan claim re-pointed
Claims processor
CLM-428926 → UHC-86763-22 (Kimberly Bell)
Member id
UHC-86763-22
Confidence
1
Method
probabilistic
MBR-018763CLM-428926
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001763
Orphan claim re-pointed
Claims processor
CLM-420852 → UHC-17253-37 (Jean Espinoza)
Member id
UHC-17253-37
Confidence
1
Method
probabilistic
MBR-018268CLM-420852
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001764
Orphan claim re-pointed
Claims processor
CLM-431108 → UHC-59244-39 (Jean McCoy)
Member id
UHC-59244-39
Confidence
0.90
Method
probabilistic
MBR-021128CLM-431108
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001765
Orphan claim re-pointed
Claims processor
CLM-400634 → UHC-86309-43 (Brian Cole)
Member id
UHC-86309-43
Confidence
1
Method
probabilistic
MBR-027696CLM-400634
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001766
Orphan claim re-pointed
Claims processor
CLM-420559 → UHC-02890-41 (Nancy Ferguson)
Member id
UHC-02890-41
Confidence
1
Method
probabilistic
MBR-015987CLM-420559
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001767
Orphan claim re-pointed
Claims processor
CLM-432307 → UHC-41143-37 (Kayla Valdez)
Member id
UHC-41143-37
Confidence
1
Method
probabilistic
MBR-004577CLM-432307
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001768
Orphan claim re-pointed
Claims processor
CLM-405655 → UHC-19050-62 (Victoria Evans)
Member id
UHC-19050-62
Confidence
1
Method
probabilistic
MBR-024954CLM-405655
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001769
Orphan claim re-pointed
Claims processor
CLM-430432 → UHC-51846-88 (Joan Medina)
Member id
UHC-51846-88
Confidence
0.97
Method
deterministic
MBR-026812CLM-430432
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001770
Orphan claim re-pointed
Claims processor
CLM-416065 → UHC-48858-85 (Ralph Myers)
Member id
UHC-48858-85
Confidence
0.94
Method
probabilistic
MBR-002827CLM-416065
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001771
Orphan claim re-pointed
Claims processor
CLM-407520 → UHC-06605-29 (Patricia Grant)
Member id
UHC-06605-29
Confidence
1
Method
probabilistic
MBR-034054CLM-407520
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001772
Orphan claim re-pointed
Claims processor
CLM-403435 → UHC-56279-29 (Ryan Patel)
Member id
UHC-56279-29
Confidence
1
Method
probabilistic
MBR-027097CLM-403435
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001773
Orphan claim re-pointed
Claims processor
CLM-425915 → UHC-60558-56 (Ruth Ross)
Member id
UHC-60558-56
Confidence
1
Method
probabilistic
MBR-001545CLM-425915
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001774
Orphan claim re-pointed
Claims processor
CLM-407151 → UHC-38319-19 (Hannah Rose)
Member id
UHC-38319-19
Confidence
1
Method
probabilistic
MBR-006459CLM-407151
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001775
Orphan claim re-pointed
Claims processor
CLM-416509 → UHC-83152-41 (Roy Watson)
Member id
UHC-83152-41
Confidence
1
Method
probabilistic
MBR-013024CLM-416509
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001776
Orphan claim re-pointed
Claims processor
CLM-425315 → UHC-76683-43 (Ralph Henderson)
Member id
UHC-76683-43
Confidence
1
Method
probabilistic
MBR-038548CLM-425315
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001777
Orphan claim re-pointed
Claims processor
CLM-401865 → UHC-30122-51 (Gary Walker)
Member id
UHC-30122-51
Confidence
1
Method
probabilistic
MBR-008924CLM-401865
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001778
Orphan claim re-pointed
Claims processor
CLM-419111 → UHC-14047-09 (Jackie Nelson)
Member id
UHC-14047-09
Confidence
1
Method
probabilistic
MBR-008961CLM-419111
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001779
Orphan claim re-pointed
Claims processor
CLM-423073 → UHC-62601-51 (Shirley Obrien)
Member id
UHC-62601-51
Confidence
1
Method
probabilistic
MBR-003413CLM-423073
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001780
Orphan claim re-pointed
Claims processor
CLM-419398 → UHC-98369-55 (Doris Fernandez)
Member id
UHC-98369-55
Confidence
1
Method
probabilistic
MBR-011047CLM-419398
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001781
Orphan claim re-pointed
Claims processor
CLM-410142 → UHC-63728-04 (William Contreras)
Member id
UHC-63728-04
Confidence
1
Method
probabilistic
MBR-012337CLM-410142
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001782
Orphan claim re-pointed
Claims processor
CLM-416034 → UHC-76735-60 (Mateo Chen)
Member id
UHC-76735-60
Confidence
0.97
Method
deterministic
MBR-006431CLM-416034
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001783
Orphan claim re-pointed
Claims processor
CLM-425345 → UHC-20067-85 (Lawrence Gutierrez)
Member id
UHC-20067-85
Confidence
0.97
Method
deterministic
MBR-017425CLM-425345
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001784
Orphan claim re-pointed
Claims processor
CLM-409016 → UHC-59953-53 (Michelle Kennedy)
Member id
UHC-59953-53
Confidence
0.97
Method
deterministic
MBR-014323CLM-409016
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001785
Orphan claim re-pointed
Claims processor
CLM-417137 → UHC-61321-56 (Christine Davis)
Member id
UHC-61321-56
Confidence
1
Method
probabilistic
MBR-008504CLM-417137
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001786
Orphan claim re-pointed
Claims processor
CLM-400555 → UHC-38544-97 (Frances Wilson)
Member id
UHC-38544-97
Confidence
1
Method
probabilistic
MBR-035057CLM-400555
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001787
Orphan claim re-pointed
Claims processor
CLM-404850 → UHC-74882-51 (Heather McDonald)
Member id
UHC-74882-51
Confidence
0.97
Method
deterministic
MBR-013495CLM-404850
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001788
Orphan claim re-pointed
Claims processor
CLM-400680 → UHC-06356-88 (Evelyn Brooks)
Member id
UHC-06356-88
Confidence
1
Method
probabilistic
MBR-022201CLM-400680
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001789
Orphan claim re-pointed
Claims processor
CLM-431545 → UHC-60838-89 (Christian Henry)
Member id
UHC-60838-89
Confidence
0.99
Method
probabilistic
MBR-008611CLM-431545
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001790
Orphan claim re-pointed
Claims processor
CLM-416278 → UHC-61491-38 (Carlos Kennedy)
Member id
UHC-61491-38
Confidence
0.99
Method
probabilistic
MBR-005824CLM-416278
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001791
Orphan claim re-pointed
Claims processor
CLM-426549 → UHC-75623-64 (Amanda Hill)
Member id
UHC-75623-64
Confidence
1
Method
probabilistic
MBR-016312CLM-426549
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001792
Orphan claim re-pointed
Claims processor
CLM-401714 → UHC-52048-24 (Andrea Holmes)
Member id
UHC-52048-24
Confidence
0.97
Method
deterministic
MBR-001288CLM-401714
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001793
Orphan claim re-pointed
Claims processor
CLM-415544 → UHC-61925-07 (Eugene Roberts)
Member id
UHC-61925-07
Confidence
1
Method
probabilistic
MBR-019238CLM-415544
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001794
Orphan claim re-pointed
Claims processor
CLM-424802 → UHC-99900-84 (Isabella Collins)
Member id
UHC-99900-84
Confidence
0.93
Method
probabilistic
MBR-027593CLM-424802
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001795
Orphan claim re-pointed
Claims processor
CLM-411640 → UHC-48356-13 (Anna Dominguez)
Member id
UHC-48356-13
Confidence
0.97
Method
deterministic
MBR-038920CLM-411640
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001796
Orphan claim re-pointed
Claims processor
CLM-425136 → UHC-65778-19 (Hiroshi Carter)
Member id
UHC-65778-19
Confidence
0.97
Method
deterministic
MBR-017140CLM-425136
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001797
Orphan claim re-pointed
Claims processor
CLM-417915 → UHC-78083-57 (Judith West)
Member id
UHC-78083-57
Confidence
1
Method
probabilistic
MBR-012031CLM-417915
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001798
Orphan claim re-pointed
Claims processor
CLM-428764 → UHC-27150-81 (Elizabeth Rose)
Member id
UHC-27150-81
Confidence
1
Method
probabilistic
MBR-004408CLM-428764
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001799
Orphan claim re-pointed
Claims processor
CLM-411367 → UHC-72162-77 (Jonathan Wheelar)
Member id
UHC-72162-77
Confidence
0.91
Method
probabilistic
MBR-007930CLM-411367
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001800
Orphan claim re-pointed
Claims processor
CLM-424869 → UHC-50104-81 (Nancy Mills)
Member id
UHC-50104-81
Confidence
0.99
Method
probabilistic
MBR-025449CLM-424869
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001801
Orphan claim re-pointed
Claims processor
CLM-419408 → UHC-41975-39 (Mary Torres)
Member id
UHC-41975-39
Confidence
1
Method
probabilistic
MBR-008793CLM-419408
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001802
Orphan claim re-pointed
Claims processor
CLM-422623 → UHC-08895-06 (Sofia Mitchell)
Member id
UHC-08895-06
Confidence
1
Method
probabilistic
MBR-010078CLM-422623
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001803
Orphan claim re-pointed
Claims processor
CLM-432356 → UHC-07217-33 (Roy James)
Member id
UHC-07217-33
Confidence
1
Method
probabilistic
MBR-019822CLM-432356
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001804
Orphan claim re-pointed
Claims processor
CLM-421438 → UHC-45310-05 (Peter Ferguson)
Member id
UHC-45310-05
Confidence
1
Method
probabilistic
MBR-008428CLM-421438
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001805
Orphan claim re-pointed
Claims processor
CLM-409592 → UHC-46398-33 (Evelyn Olson)
Member id
UHC-46398-33
Confidence
1
Method
probabilistic
MBR-014138CLM-409592
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001806
Orphan claim re-pointed
Claims processor
CLM-404459 → UHC-48249-92 (Kelly Baker)
Member id
UHC-48249-92
Confidence
1
Method
probabilistic
MBR-000761CLM-404459
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001807
Orphan claim re-pointed
Claims processor
CLM-426951 → UHC-06715-98 (Karen Powell)
Member id
UHC-06715-98
Confidence
1
Method
probabilistic
MBR-006911CLM-426951
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001808
Orphan claim re-pointed
Claims processor
CLM-422007 → UHC-67569-41 (Ruth Sandoval)
Member id
UHC-67569-41
Confidence
0.97
Method
deterministic
MBR-016803CLM-422007
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001809
Orphan claim re-pointed
Claims processor
CLM-421899 → UHC-80433-48 (Alexis Price)
Member id
UHC-80433-48
Confidence
1
Method
probabilistic
MBR-025040CLM-421899
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001810
Orphan claim re-pointed
Claims processor
CLM-410413 → UHC-67055-02 (Fatima Nunez)
Member id
UHC-67055-02
Confidence
0.97
Method
deterministic
MBR-018025CLM-410413
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001811
Orphan claim re-pointed
Claims processor
CLM-417860 → UHC-67304-99 (Kevin Walker)
Member id
UHC-67304-99
Confidence
1
Method
probabilistic
MBR-001569CLM-417860
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 174 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.