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-002362
Orphan claim re-pointed
Claims processor
CLM-400093 → UHC-20548-27 (Christian Contreras)
Member id
UHC-20548-27
Confidence
1
Method
probabilistic
MBR-005649CLM-400093
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002363
Orphan claim re-pointed
Claims processor
CLM-411635 → UHC-26238-80 (Olivia Vasquez)
Member id
UHC-26238-80
Confidence
1
Method
probabilistic
MBR-001051CLM-411635
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002364
Orphan claim re-pointed
Claims processor
CLM-428727 → UHC-66793-44 (Julie Simmons)
Member id
UHC-66793-44
Confidence
1
Method
probabilistic
MBR-021801CLM-428727
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002365
Orphan claim re-pointed
Claims processor
CLM-406154 → UHC-38894-44 (Austin Robertson)
Member id
UHC-38894-44
Confidence
0.97
Method
deterministic
MBR-005940CLM-406154
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002366
Orphan claim re-pointed
Claims processor
CLM-408172 → UHC-89231-07 (Virginia Hanson)
Member id
UHC-89231-07
Confidence
0.98
Method
probabilistic
MBR-036877CLM-408172
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002367
Orphan claim re-pointed
Claims processor
CLM-409415 → UHC-91857-26 (Kenneth Stewart)
Member id
UHC-91857-26
Confidence
0.99
Method
probabilistic
MBR-002169CLM-409415
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002368
Orphan claim re-pointed
Claims processor
CLM-417536 → UHC-80596-07 (Alexis Tran)
Member id
UHC-80596-07
Confidence
1
Method
probabilistic
MBR-023156CLM-417536
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002369
Orphan claim re-pointed
Claims processor
CLM-417887 → UHC-80625-58 (Paul Lucas)
Member id
UHC-80625-58
Confidence
1
Method
probabilistic
MBR-033099CLM-417887
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002370
Orphan claim re-pointed
Claims processor
CLM-407667 → UHC-95333-52 (Kevin Scott)
Member id
UHC-95333-52
Confidence
0.99
Method
probabilistic
MBR-005413CLM-407667
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002371
Orphan claim re-pointed
Claims processor
CLM-425684 → UHC-34145-47 (Scott Moreno)
Member id
UHC-34145-47
Confidence
1
Method
probabilistic
MBR-008319CLM-425684
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002372
Orphan claim re-pointed
Claims processor
CLM-427375 → UHC-37268-78 (Ana Cox)
Member id
UHC-37268-78
Confidence
0.97
Method
deterministic
MBR-029154CLM-427375
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002373
Orphan claim re-pointed
Claims processor
CLM-413170 → UHC-56626-27 (Bryan Silva)
Member id
UHC-56626-27
Confidence
1
Method
probabilistic
MBR-021670CLM-413170
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002374
Orphan claim re-pointed
Claims processor
CLM-414182 → UHC-37191-90 (Sophia Cole)
Member id
UHC-37191-90
Confidence
1
Method
probabilistic
MBR-027859CLM-414182
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002375
Orphan claim re-pointed
Claims processor
CLM-407116 → UHC-33209-09 (Jesse Spencer)
Member id
UHC-33209-09
Confidence
0.97
Method
deterministic
MBR-026693CLM-407116
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002376
Orphan claim re-pointed
Claims processor
CLM-400158 → UHC-50673-74 (Elizabeth Castro)
Member id
UHC-50673-74
Confidence
1
Method
probabilistic
MBR-012382CLM-400158
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002377
Orphan claim re-pointed
Claims processor
CLM-419329 → UHC-68157-21 (Ann Hudson)
Member id
UHC-68157-21
Confidence
1
Method
probabilistic
MBR-002370CLM-419329
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002378
Orphan claim re-pointed
Claims processor
CLM-427863 → UHC-36934-77 (Wayne Wright)
Member id
UHC-36934-77
Confidence
1
Method
probabilistic
MBR-035529CLM-427863
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002379
Orphan claim re-pointed
Claims processor
CLM-417566 → UHC-97967-62 (Don Richardson)
Member id
UHC-97967-62
Confidence
1
Method
probabilistic
MBR-006319CLM-417566
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002380
Orphan claim re-pointed
Claims processor
CLM-400417 → UHC-70906-85 (Stephen Vasquez)
Member id
UHC-70906-85
Confidence
1
Method
probabilistic
MBR-004094CLM-400417
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002381
Orphan claim re-pointed
Claims processor
CLM-427496 → UHC-98629-39 (Logan Ortiz)
Member id
UHC-98629-39
Confidence
1
Method
probabilistic
MBR-010087CLM-427496
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002382
Orphan claim re-pointed
Claims processor
CLM-428400 → UHC-75643-38 (Jeremy Green)
Member id
UHC-75643-38
Confidence
0.97
Method
deterministic
MBR-025435CLM-428400
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002383
Orphan claim re-pointed
Claims processor
CLM-414438 → UHC-27182-89 (Wei Washington)
Member id
UHC-27182-89
Confidence
1
Method
probabilistic
MBR-012530CLM-414438
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002384
Orphan claim re-pointed
Claims processor
CLM-406107 → UHC-14438-70 (Adam Collins)
Member id
UHC-14438-70
Confidence
1
Method
probabilistic
MBR-025911CLM-406107
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002385
Orphan claim re-pointed
Claims processor
CLM-424383 → UHC-28200-70 (Richard Chapman)
Member id
UHC-28200-70
Confidence
1
Method
probabilistic
MBR-014158CLM-424383
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002386
Orphan claim re-pointed
Claims processor
CLM-407095 → UHC-75104-95 (Ahmed Ortiz)
Member id
UHC-75104-95
Confidence
0.93
Method
probabilistic
MBR-011779CLM-407095
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002387
Orphan claim re-pointed
Claims processor
CLM-419149 → UHC-18122-11 (Laura Morris)
Member id
UHC-18122-11
Confidence
1
Method
probabilistic
MBR-022642CLM-419149
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002388
Orphan claim re-pointed
Claims processor
CLM-408034 → UHC-50421-83 (Steven Miller)
Member id
UHC-50421-83
Confidence
0.93
Method
probabilistic
MBR-023854CLM-408034
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002389
Orphan claim re-pointed
Claims processor
CLM-414402 → UHC-25825-42 (Danielle Ramirez)
Member id
UHC-25825-42
Confidence
1
Method
probabilistic
MBR-022951CLM-414402
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002390
Orphan claim re-pointed
Claims processor
CLM-429445 → UHC-81319-46 (Anna Reed)
Member id
UHC-81319-46
Confidence
1
Method
probabilistic
MBR-024442CLM-429445
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002391
Orphan claim re-pointed
Claims processor
CLM-412702 → UHC-74593-20 (Abigail Alexander)
Member id
UHC-74593-20
Confidence
1
Method
probabilistic
MBR-009673CLM-412702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002392
Orphan claim re-pointed
Claims processor
CLM-400926 → UHC-87411-86 (Priya Chen)
Member id
UHC-87411-86
Confidence
1
Method
probabilistic
MBR-019814CLM-400926
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002393
Orphan claim re-pointed
Claims processor
CLM-410360 → UHC-08481-83 (Ahmed Riley)
Member id
UHC-08481-83
Confidence
0.93
Method
probabilistic
MBR-005205CLM-410360
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002394
Orphan claim re-pointed
Claims processor
CLM-411189 → UHC-54546-12 (Dorothy Richardson)
Member id
UHC-54546-12
Confidence
1
Method
probabilistic
MBR-021749CLM-411189
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002395
Orphan claim re-pointed
Claims processor
CLM-420441 → UHC-06383-65 (Omar Allen)
Member id
UHC-06383-65
Confidence
1
Method
probabilistic
MBR-041251CLM-420441
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002396
Orphan claim re-pointed
Claims processor
CLM-411414 → UHC-09246-17 (Vincent Stewart)
Member id
UHC-09246-17
Confidence
0.93
Method
probabilistic
MBR-029577CLM-411414
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002397
Orphan claim re-pointed
Claims processor
CLM-430115 → UHC-11860-11 (Isabella Gardner)
Member id
UHC-11860-11
Confidence
1
Method
probabilistic
MBR-026618CLM-430115
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002398
Orphan claim re-pointed
Claims processor
CLM-424317 → UHC-64314-13 (Emily Ortega)
Member id
UHC-64314-13
Confidence
1
Method
probabilistic
MBR-012619CLM-424317
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002399
Orphan claim re-pointed
Claims processor
CLM-407504 → UHC-59108-59 (Julie Lee)
Member id
UHC-59108-59
Confidence
0.97
Method
deterministic
MBR-004797CLM-407504
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002400
Orphan claim re-pointed
Claims processor
CLM-408714 → UHC-67709-41 (Vincent Gordon)
Member id
UHC-67709-41
Confidence
0.97
Method
deterministic
MBR-007178CLM-408714
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002401
Orphan claim re-pointed
Claims processor
CLM-421217 → UHC-66217-85 (Randy Carlson)
Member id
UHC-66217-85
Confidence
0.97
Method
deterministic
MBR-011530CLM-421217
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002402
Orphan claim re-pointed
Claims processor
CLM-401266 → UHC-18585-05 (Marilyn Long)
Member id
UHC-18585-05
Confidence
0.97
Method
deterministic
MBR-025851CLM-401266
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002403
Orphan claim re-pointed
Claims processor
CLM-431256 → UHC-05043-11 (Andrew Lopez)
Member id
UHC-05043-11
Confidence
1
Method
probabilistic
MBR-042495CLM-431256
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002404
Orphan claim re-pointed
Claims processor
CLM-403678 → UHC-38568-32 (Frank Williamson)
Member id
UHC-38568-32
Confidence
1
Method
probabilistic
MBR-030747CLM-403678
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002405
Orphan claim re-pointed
Claims processor
CLM-404838 → UHC-08285-02 (Elizabeth Simmons)
Member id
UHC-08285-02
Confidence
1
Method
probabilistic
MBR-011390CLM-404838
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002406
Orphan claim re-pointed
Claims processor
CLM-409574 → UHC-33964-15 (Heather Welch)
Member id
UHC-33964-15
Confidence
1
Method
probabilistic
MBR-037423CLM-409574
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002407
Orphan claim re-pointed
Claims processor
CLM-405512 → UHC-96469-23 (Kathryn Lawson)
Member id
UHC-96469-23
Confidence
1
Method
probabilistic
MBR-031304CLM-405512
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002408
Orphan claim re-pointed
Claims processor
CLM-432787 → UHC-30731-01 (Deborah Rose)
Member id
UHC-30731-01
Confidence
1.00
Method
probabilistic
MBR-005250CLM-432787
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002409
Orphan claim re-pointed
Claims processor
CLM-416336 → UHC-28968-52 (Betty Soto)
Member id
UHC-28968-52
Confidence
0.97
Method
deterministic
MBR-008203CLM-416336
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002410
Orphan claim re-pointed
Claims processor
CLM-408469 → UHC-21549-44 (Joan Johnston)
Member id
UHC-21549-44
Confidence
0.97
Method
deterministic
MBR-021984CLM-408469
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002411
Orphan claim re-pointed
Claims processor
CLM-410778 → UHC-21935-35 (William Estrada)
Member id
UHC-21935-35
Confidence
1
Method
probabilistic
MBR-007788CLM-410778
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 186 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.