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
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-002412 | Orphan claim re-pointed Claims processor | CLM-426453 → UHC-13952-43 (Margaret Weaver) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002413 | Orphan claim re-pointed Claims processor | CLM-412643 → UHC-23556-43 (Andrea Sanders) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002414 | Orphan claim re-pointed Claims processor | CLM-403331 → UHC-81477-97 (Teresa Hayes) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002415 | Orphan claim re-pointed Claims processor | CLM-412388 → UHC-11519-51 (Linda Perkins) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002416 | Orphan claim re-pointed Claims processor | CLM-421379 → UHC-70202-76 (Dylan Bowman) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002417 | Orphan claim re-pointed Claims processor | CLM-403800 → UHC-30857-34 (Frances Jacobs) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002418 | Orphan claim re-pointed Claims processor | CLM-421854 → UHC-38780-55 (Eric Watson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002419 | Orphan claim re-pointed Claims processor | CLM-403979 → UHC-51075-25 (Timothy Arnold) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002420 | Orphan claim re-pointed Claims processor | CLM-417990 → UHC-32000-97 (Jennifer West) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002421 | Orphan claim re-pointed Claims processor | CLM-431770 → UHC-27459-40 (Jose Rodriguez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002422 | Orphan claim re-pointed Claims processor | CLM-410974 → UHC-37259-61 (Nicholas Aguilar) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002423 | Orphan claim re-pointed Claims processor | CLM-424015 → UHC-74572-28 (Ethan Rose) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002424 | Orphan claim re-pointed Claims processor | CLM-430684 → UHC-45678-94 (Sophia Black) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002425 | Orphan claim re-pointed Claims processor | CLM-428184 → UHC-06932-65 (Dylan Greene) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002426 | Orphan claim re-pointed Claims processor | CLM-431649 → UHC-75916-95 (Samuel Ryan) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002427 | Orphan claim re-pointed Claims processor | CLM-402196 → UHC-02849-78 (Susan Morris) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002428 | Orphan claim re-pointed Claims processor | CLM-421461 → UHC-12228-04 (Juan Kelly) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002429 | Orphan claim re-pointed Claims processor | CLM-408227 → UHC-35780-70 (Julia Carroll) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002430 | Orphan claim re-pointed Claims processor | CLM-430199 → UHC-22797-90 (Philip Olson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002431 | Orphan claim re-pointed Claims processor | CLM-413884 → UHC-33252-46 (Patricia Patel) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002432 | Orphan claim re-pointed Claims processor | CLM-409002 → UHC-19821-29 (Alice Reid) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002433 | Orphan claim re-pointed Claims processor | CLM-401518 → UHC-77889-07 (Ronald Gonzales) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002434 | Orphan claim re-pointed Claims processor | CLM-414728 → UHC-82089-15 (Janet Munoz) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002435 | Orphan claim re-pointed Claims processor | CLM-402974 → UHC-03290-88 (Fatima Webb) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002436 | Orphan claim re-pointed Claims processor | CLM-414815 → UHC-49101-83 (Bruce Hansen) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002437 | Orphan claim re-pointed Claims processor | CLM-422173 → UHC-28139-43 (Lori Robinson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002438 | Orphan claim re-pointed Claims processor | CLM-431156 → UHC-77450-32 (Helen Munoz) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002439 | Orphan claim re-pointed Claims processor | CLM-402353 → UHC-78850-61 (Ralph Woods) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002440 | Orphan claim re-pointed Claims processor | CLM-419022 → UHC-01306-79 (Katherine Aguilar) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002441 | Orphan claim re-pointed Claims processor | CLM-430784 → UHC-48702-23 (Catherine Marshall) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002442 | Orphan claim re-pointed Claims processor | CLM-429290 → UHC-96611-25 (Virginia Wong) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002443 | Orphan claim re-pointed Claims processor | CLM-420313 → UHC-05181-14 (Gregory Smith) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002444 | Orphan claim re-pointed Claims processor | CLM-420775 → UHC-65981-16 (Carol Jacobs) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002445 | Orphan claim re-pointed Claims processor | CLM-425868 → UHC-04795-68 (Bobby Schultz) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002446 | Orphan claim re-pointed Claims processor | CLM-431797 → UHC-22691-20 (Catherine Carroll) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002447 | Orphan claim re-pointed Claims processor | CLM-420526 → UHC-53502-65 (George Lopez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002448 | Orphan claim re-pointed Claims processor | CLM-402898 → UHC-27015-08 (Wayne Coleman) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002449 | Orphan claim re-pointed Claims processor | CLM-425930 → UHC-45484-10 (Daaniel Snyder) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002450 | Orphan claim re-pointed Claims processor | CLM-416362 → UHC-86273-40 (Bradley Burton) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002451 | Orphan claim re-pointed Claims processor | CLM-403232 → UHC-57532-56 (Raymond Salazar) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002452 | Orphan claim re-pointed Claims processor | CLM-409414 → UHC-24069-93 (Bobby Harper) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002453 | Orphan claim re-pointed Claims processor | CLM-422613 → UHC-61358-72 (Carlos Williamson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002454 | Orphan claim re-pointed Claims processor | CLM-419859 → UHC-32095-94 (Julie Maldonado) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002455 | Orphan claim re-pointed Claims processor | CLM-424888 → UHC-11310-74 (Dennis Hernandez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002456 | Orphan claim re-pointed Claims processor | CLM-424109 → UHC-22742-24 (Omar Ferguson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002457 | Orphan claim re-pointed Claims processor | CLM-431888 → UHC-07580-34 (Diego Evans) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002458 | Orphan claim re-pointed Claims processor | CLM-408931 → UHC-92591-12 (Kevin Powell) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002459 | Orphan claim re-pointed Claims processor | CLM-421878 → UHC-29411-66 (Maria Simpson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002460 | Orphan claim re-pointed Claims processor | CLM-400042 → UHC-28042-53 (Eric James) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-002461 | Orphan claim re-pointed Claims processor | CLM-421023 → UHC-52595-90 (Justin Griffin) |
| Executed | resolution_agent 2026-10-22 12:47:23 |
Derivation rules
Evaluated after every gold rebuild
- 1Eligibility conflict resolvedThe records behind one identity disagree on plan code. Survivorship picks the enrollment plan; the eligibility engine is told which one is canonical.
- 2Orphan claim re-pointedA 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.
- 3Outreach address correctedThe most recent address on the golden record differs from what enrollment holds. Outreach gets the current address before the next mailing.
- 4Outreach suppressed pending stewardThe record is sitting in an open steward case. Nothing sensitive is sent until a person decides, so we never message the wrong member.
- 5Care coordination outreachThree or more claims and no provider record. Next-best-action proposes assigning a PCP and scheduling a care-coordination call.
- 6New member onboardingA single, fresh enrollment with no other activity yet. Next-best-action proposes the welcome kit and a digital ID card.
- 7Duplicate member record retiredTwo or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.