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-002562
Orphan claim re-pointed
Claims processor
CLM-424149 → UHC-12380-01 (Angela Woods)
Member id
UHC-12380-01
Confidence
0.98
Method
probabilistic
MBR-002606CLM-424149
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002563
Orphan claim re-pointed
Claims processor
CLM-415028 → UHC-11917-91 (Lori Campbell)
Member id
UHC-11917-91
Confidence
1
Method
probabilistic
MBR-012210CLM-415028
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002564
Orphan claim re-pointed
Claims processor
CLM-424520 → UHC-65748-45 (Theresa Knight)
Member id
UHC-65748-45
Confidence
1
Method
probabilistic
MBR-030345CLM-424520
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002565
Orphan claim re-pointed
Claims processor
CLM-401706 → UHC-32789-96 (Linda Weaver)
Member id
UHC-32789-96
Confidence
0.97
Method
deterministic
MBR-038179CLM-401706
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002566
Orphan claim re-pointed
Claims processor
CLM-425786 → UHC-78142-72 (Danielle Bradley)
Member id
UHC-78142-72
Confidence
1
Method
probabilistic
MBR-007872CLM-425786
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002567
Orphan claim re-pointed
Claims processor
CLM-427526 → UHC-80435-97 (Ann Silva)
Member id
UHC-80435-97
Confidence
1
Method
probabilistic
MBR-015008CLM-427526
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002568
Orphan claim re-pointed
Claims processor
CLM-406081 → UHC-61162-85 (George Fernandez)
Member id
UHC-61162-85
Confidence
1
Method
probabilistic
MBR-001598CLM-406081
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002569
Orphan claim re-pointed
Claims processor
CLM-430649 → UHC-22421-51 (Sharon Davis)
Member id
UHC-22421-51
Confidence
0.97
Method
deterministic
MBR-011038CLM-430649
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002570
Orphan claim re-pointed
Claims processor
CLM-431543 → UHC-37191-05 (Patricia Parker)
Member id
UHC-37191-05
Confidence
1
Method
probabilistic
MBR-006359CLM-431543
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002571
Orphan claim re-pointed
Claims processor
CLM-415157 → UHC-07746-98 (Martha Green)
Member id
UHC-07746-98
Confidence
1
Method
probabilistic
MBR-006205CLM-415157
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002572
Orphan claim re-pointed
Claims processor
CLM-416943 → UHC-53088-33 (Dorothy Padilla)
Member id
UHC-53088-33
Confidence
1
Method
probabilistic
MBR-007320CLM-416943
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002573
Orphan claim re-pointed
Claims processor
CLM-418261 → UHC-73471-18 (Jonathan Ferguson)
Member id
UHC-73471-18
Confidence
0.87
Method
probabilistic
MBR-026583CLM-418261
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002574
Orphan claim re-pointed
Claims processor
CLM-423112 → UHC-01497-69 (Gloria Dominguez)
Member id
UHC-01497-69
Confidence
1
Method
probabilistic
MBR-026997CLM-423112
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002575
Orphan claim re-pointed
Claims processor
CLM-424390 → UHC-55213-66 (Jacqueline Lewis)
Member id
UHC-55213-66
Confidence
0.93
Method
probabilistic
MBR-004299CLM-424390
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002576
Orphan claim re-pointed
Claims processor
CLM-430107 → UHC-50719-93 (Carlos Boyd)
Member id
UHC-50719-93
Confidence
0.97
Method
deterministic
MBR-020053CLM-430107
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002577
Orphan claim re-pointed
Claims processor
CLM-416103 → UHC-58764-26 (Edward Arnold)
Member id
UHC-58764-26
Confidence
1
Method
probabilistic
MBR-017494CLM-416103
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002578
Orphan claim re-pointed
Claims processor
CLM-403207 → UHC-46795-50 (Betty Allen)
Member id
UHC-46795-50
Confidence
1
Method
probabilistic
MBR-008073CLM-403207
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002579
Orphan claim re-pointed
Claims processor
CLM-430775 → UHC-10883-60 (Carol Cook)
Member id
UHC-10883-60
Confidence
1
Method
probabilistic
MBR-007688CLM-430775
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002580
Orphan claim re-pointed
Claims processor
CLM-411644 → UHC-25176-33 (Adam Alvarado)
Member id
UHC-25176-33
Confidence
1
Method
probabilistic
MBR-026445CLM-411644
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002581
Orphan claim re-pointed
Claims processor
CLM-411207 → UHC-80098-32 (Helen Robinson)
Member id
UHC-80098-32
Confidence
1
Method
probabilistic
MBR-013743CLM-411207
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002582
Orphan claim re-pointed
Claims processor
CLM-404246 → UHC-14129-58 (Juhn Sullivan)
Member id
UHC-14129-58
Confidence
0.97
Method
probabilistic
MBR-030628CLM-404246
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002583
Orphan claim re-pointed
Claims processor
CLM-425070 → UHC-85183-78 (Joan Fowler)
Member id
UHC-85183-78
Confidence
1
Method
probabilistic
MBR-003885CLM-425070
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002584
Orphan claim re-pointed
Claims processor
CLM-422860 → UHC-54454-59 (Cynthia Ortega)
Member id
UHC-54454-59
Confidence
1
Method
probabilistic
MBR-002916CLM-422860
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002585
Orphan claim re-pointed
Claims processor
CLM-431268 → UHC-15710-14 (Alice Ortiz)
Member id
UHC-15710-14
Confidence
1
Method
probabilistic
MBR-000574CLM-431268
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002586
Orphan claim re-pointed
Claims processor
CLM-421254 → UHC-04073-64 (Lisa Li)
Member id
UHC-04073-64
Confidence
0.97
Method
deterministic
MBR-026049CLM-421254
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002587
Orphan claim re-pointed
Claims processor
CLM-430499 → UHC-17326-17 (Albert Weaver)
Member id
UHC-17326-17
Confidence
0.98
Method
probabilistic
MBR-043634CLM-430499
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002588
Orphan claim re-pointed
Claims processor
CLM-406453 → UHC-47380-81 (Brennda Santiago)
Member id
UHC-47380-81
Confidence
0.97
Method
deterministic
MBR-024898CLM-406453
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002589
Orphan claim re-pointed
Claims processor
CLM-414637 → UHC-71285-92 (Evelyn Hawkins)
Member id
UHC-71285-92
Confidence
1
Method
probabilistic
MBR-019493CLM-414637
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002590
Orphan claim re-pointed
Claims processor
CLM-414228 → UHC-88973-05 (Jesse Reyes)
Member id
UHC-88973-05
Confidence
0.94
Method
probabilistic
MBR-009347CLM-414228
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002591
Orphan claim re-pointed
Claims processor
CLM-404597 → UHC-74176-39 (Gay Hansen)
Member id
UHC-74176-39
Confidence
0.97
Method
deterministic
MBR-022718CLM-404597
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002592
Orphan claim re-pointed
Claims processor
CLM-428924 → UHC-50088-36 (Frank Woods)
Member id
UHC-50088-36
Confidence
0.97
Method
deterministic
MBR-043538CLM-428924
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002593
Orphan claim re-pointed
Claims processor
CLM-430043 → UHC-98864-36 (Mei Walsh)
Member id
UHC-98864-36
Confidence
1
Method
probabilistic
MBR-018523CLM-430043
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002594
Orphan claim re-pointed
Claims processor
CLM-401058 → UHC-17944-90 (Charles Hunter)
Member id
UHC-17944-90
Confidence
1
Method
probabilistic
MBR-009945CLM-401058
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002595
Orphan claim re-pointed
Claims processor
CLM-417727 → UHC-36471-89 (Logan Yang)
Member id
UHC-36471-89
Confidence
1
Method
probabilistic
MBR-001834CLM-417727
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002596
Orphan claim re-pointed
Claims processor
CLM-431950 → UHC-02686-18 (Michael Kim)
Member id
UHC-02686-18
Confidence
1
Method
probabilistic
MBR-014632CLM-431950
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002597
Orphan claim re-pointed
Claims processor
CLM-429309 → UHC-31006-41 (Julia Thomas)
Member id
UHC-31006-41
Confidence
1
Method
probabilistic
MBR-005836CLM-429309
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002598
Orphan claim re-pointed
Claims processor
CLM-416421 → UHC-97338-53 (Jean Ortega)
Member id
UHC-97338-53
Confidence
1
Method
probabilistic
MBR-009896CLM-416421
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002599
Orphan claim re-pointed
Claims processor
CLM-408903 → UHC-27788-70 (Marcus Snyder)
Member id
UHC-27788-70
Confidence
1
Method
probabilistic
MBR-013543CLM-408903
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002600
Orphan claim re-pointed
Claims processor
CLM-407376 → UHC-46306-19 (Diana Jacobs)
Member id
UHC-46306-19
Confidence
1
Method
probabilistic
MBR-015575CLM-407376
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002601
Orphan claim re-pointed
Claims processor
CLM-425201 → UHC-86751-24 (Jean Gonzales)
Member id
UHC-86751-24
Confidence
1
Method
probabilistic
MBR-029861CLM-425201
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002602
Orphan claim re-pointed
Claims processor
CLM-400667 → UHC-05200-44 (Brandon Carlson)
Member id
UHC-05200-44
Confidence
1
Method
probabilistic
MBR-018558CLM-400667
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002603
Orphan claim re-pointed
Claims processor
CLM-410215 → UHC-94532-50 (Gary West)
Member id
UHC-94532-50
Confidence
1
Method
probabilistic
MBR-000246CLM-410215
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002604
Orphan claim re-pointed
Claims processor
CLM-420628 → UHC-95518-50 (Stephanie Ross)
Member id
UHC-95518-50
Confidence
0.99
Method
probabilistic
MBR-000350CLM-420628
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002605
Orphan claim re-pointed
Claims processor
CLM-422817 → UHC-88098-43 (Cheryl Barnes)
Member id
UHC-88098-43
Confidence
1
Method
probabilistic
MBR-017169CLM-422817
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002606
Orphan claim re-pointed
Claims processor
CLM-401567 → UHC-32594-17 (Mei Sullivan)
Member id
UHC-32594-17
Confidence
1
Method
probabilistic
MBR-029899CLM-401567
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002607
Orphan claim re-pointed
Claims processor
CLM-407117 → UHC-06338-10 (Sharon Rogers)
Member id
UHC-06338-10
Confidence
0.97
Method
deterministic
MBR-032035CLM-407117
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002608
Orphan claim re-pointed
Claims processor
CLM-418504 → UHC-77781-56 (Ralph Montgomery)
Member id
UHC-77781-56
Confidence
1
Method
probabilistic
MBR-006999CLM-418504
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002609
Orphan claim re-pointed
Claims processor
CLM-404820 → UHC-77984-19 (Steven Estrada)
Member id
UHC-77984-19
Confidence
1
Method
probabilistic
MBR-018073CLM-404820
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002610
Orphan claim re-pointed
Claims processor
CLM-403246 → UHC-66774-91 (Kenneth Martinez)
Member id
UHC-66774-91
Confidence
1
Method
probabilistic
MBR-016078CLM-403246
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002611
Orphan claim re-pointed
Claims processor
CLM-401832 → UHC-16187-17 (Ryan Brooks)
Member id
UHC-16187-17
Confidence
1
Method
probabilistic
MBR-006907CLM-401832
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 190 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.