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-002662
Orphan claim re-pointed
Claims processor
CLM-428009 → UHC-38382-18 (Sophia Johnston)
Member id
UHC-38382-18
Confidence
0.97
Method
deterministic
MBR-023074CLM-428009
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002663
Orphan claim re-pointed
Claims processor
CLM-401896 → UHC-66047-99 (Ruth Larson)
Member id
UHC-66047-99
Confidence
1
Method
probabilistic
MBR-005350CLM-401896
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002664
Orphan claim re-pointed
Claims processor
CLM-421602 → UHC-05399-64 (Shirley Gilbert)
Member id
UHC-05399-64
Confidence
1
Method
probabilistic
MBR-006765CLM-421602
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002665
Orphan claim re-pointed
Claims processor
CLM-401746 → UHC-06356-65 (Bradley Rice)
Member id
UHC-06356-65
Confidence
0.97
Method
deterministic
MBR-027357CLM-401746
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002666
Orphan claim re-pointed
Claims processor
CLM-424687 → UHC-93030-14 (Teresa Johnson)
Member id
UHC-93030-14
Confidence
0.99
Method
probabilistic
MBR-015085CLM-424687
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002667
Orphan claim re-pointed
Claims processor
CLM-408686 → UHC-77500-44 (Evelyn Ramos)
Member id
UHC-77500-44
Confidence
1
Method
probabilistic
MBR-001377CLM-408686
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002668
Orphan claim re-pointed
Claims processor
CLM-429281 → UHC-47017-38 (Larson Lori)
Member id
UHC-47017-38
Confidence
0.98
Method
probabilistic
MBR-036882CLM-429281
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002669
Orphan claim re-pointed
Claims processor
CLM-417702 → UHC-65290-08 (Elizabeth Stephens)
Member id
UHC-65290-08
Confidence
1
Method
probabilistic
MBR-007360CLM-417702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002670
Orphan claim re-pointed
Claims processor
CLM-427725 → UHC-47612-02 (Albert Delgado)
Member id
UHC-47612-02
Confidence
0.97
Method
deterministic
MBR-009146CLM-427725
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002671
Orphan claim re-pointed
Claims processor
CLM-426738 → UHC-52496-34 (Camila Kim)
Member id
UHC-52496-34
Confidence
1
Method
probabilistic
MBR-011329CLM-426738
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002672
Orphan claim re-pointed
Claims processor
CLM-429313 → UHC-34231-96 (Joseph Hanson)
Member id
UHC-34231-96
Confidence
1
Method
probabilistic
MBR-015461CLM-429313
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002673
Orphan claim re-pointed
Claims processor
CLM-413804 → UHC-39549-73 (Henry Johnson)
Member id
UHC-39549-73
Confidence
1
Method
probabilistic
MBR-006125CLM-413804
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002674
Orphan claim re-pointed
Claims processor
CLM-421303 → UHC-41567-67 (Chris Ferguson)
Member id
UHC-41567-67
Confidence
1
Method
probabilistic
MBR-009596CLM-421303
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002675
Orphan claim re-pointed
Claims processor
CLM-422027 → UHC-84353-34 (Cynthia Jenkins)
Member id
UHC-84353-34
Confidence
1
Method
probabilistic
MBR-027951CLM-422027
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002676
Orphan claim re-pointed
Claims processor
CLM-418162 → UHC-42273-50 (Dorothy Bailey)
Member id
UHC-42273-50
Confidence
1
Method
probabilistic
MBR-025074CLM-418162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002677
Orphan claim re-pointed
Claims processor
CLM-426235 → UHC-19670-66 (Amanda Castillo)
Member id
UHC-19670-66
Confidence
1
Method
probabilistic
MBR-024592CLM-426235
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002678
Orphan claim re-pointed
Claims processor
CLM-430566 → UHC-34472-84 (Logan Greene)
Member id
UHC-34472-84
Confidence
1
Method
probabilistic
MBR-013376CLM-430566
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002679
Orphan claim re-pointed
Claims processor
CLM-430098 → UHC-42568-28 (Valentina Williams)
Member id
UHC-42568-28
Confidence
1
Method
probabilistic
MBR-002396CLM-430098
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002680
Orphan claim re-pointed
Claims processor
CLM-420025 → UHC-42568-66 (Kayla Richards)
Member id
UHC-42568-66
Confidence
1
Method
probabilistic
MBR-009104CLM-420025
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002681
Orphan claim re-pointed
Claims processor
CLM-407528 → UHC-43700-15 (Justin Little)
Member id
UHC-43700-15
Confidence
0.97
Method
deterministic
MBR-006682CLM-407528
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002682
Orphan claim re-pointed
Claims processor
CLM-425852 → UHC-90457-58 (Alexis Mitchell)
Member id
UHC-90457-58
Confidence
1
Method
probabilistic
MBR-010288CLM-425852
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002683
Orphan claim re-pointed
Claims processor
CLM-410117 → UHC-23636-43 (Cheryl Vazquez)
Member id
UHC-23636-43
Confidence
1
Method
probabilistic
MBR-018548CLM-410117
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002684
Orphan claim re-pointed
Claims processor
CLM-403864 → UHC-70659-16 (Megan Richardson)
Member id
UHC-70659-16
Confidence
0.88
Method
probabilistic
MBR-033626CLM-403864
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002685
Orphan claim re-pointed
Claims processor
CLM-418702 → UHC-85993-86 (Paul Martinez)
Member id
UHC-85993-86
Confidence
0.97
Method
deterministic
MBR-025859CLM-418702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002686
Orphan claim re-pointed
Claims processor
CLM-423340 → UHC-29270-37 (Robert Watkins)
Member id
UHC-29270-37
Confidence
1
Method
probabilistic
MBR-012317CLM-423340
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002687
Orphan claim re-pointed
Claims processor
CLM-432519 → UHC-90246-63 (Joe Stevens)
Member id
UHC-90246-63
Confidence
1
Method
probabilistic
MBR-014923CLM-432519
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002688
Orphan claim re-pointed
Claims processor
CLM-402089 → UHC-88323-46 (Thomas Harvey)
Member id
UHC-88323-46
Confidence
1
Method
probabilistic
MBR-017601CLM-402089
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002689
Orphan claim re-pointed
Claims processor
CLM-431876 → UHC-49823-74 (Patrick Padilla)
Member id
UHC-49823-74
Confidence
0.97
Method
deterministic
MBR-020833CLM-431876
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002690
Orphan claim re-pointed
Claims processor
CLM-406329 → UHC-91616-29 (Susan Cruz)
Member id
UHC-91616-29
Confidence
1
Method
probabilistic
MBR-014172CLM-406329
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002691
Orphan claim re-pointed
Claims processor
CLM-425469 → UHC-53604-06 (Steven Ramos)
Member id
UHC-53604-06
Confidence
1
Method
probabilistic
MBR-008981CLM-425469
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002692
Orphan claim re-pointed
Claims processor
CLM-429993 → UHC-17287-55 (Terry Henderson)
Member id
UHC-17287-55
Confidence
0.97
Method
deterministic
MBR-010560CLM-429993
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002693
Orphan claim re-pointed
Claims processor
CLM-400729 → UHC-76291-34 (Jacob Grant)
Member id
UHC-76291-34
Confidence
1
Method
probabilistic
MBR-020476CLM-400729
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002694
Orphan claim re-pointed
Claims processor
CLM-418295 → UHC-97403-22 (Angela Matthews)
Member id
UHC-97403-22
Confidence
1
Method
probabilistic
MBR-031136CLM-418295
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002695
Orphan claim re-pointed
Claims processor
CLM-416236 → UHC-02195-39 (Gloria Harper)
Member id
UHC-02195-39
Confidence
0.99
Method
probabilistic
MBR-014309CLM-416236
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002696
Orphan claim re-pointed
Claims processor
CLM-432609 → UHC-25299-76 (Christina Williams)
Member id
UHC-25299-76
Confidence
1
Method
probabilistic
MBR-028438CLM-432609
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002697
Orphan claim re-pointed
Claims processor
CLM-406300 → UHC-68741-60 (Joyce Palmer)
Member id
UHC-68741-60
Confidence
1
Method
probabilistic
MBR-003453CLM-406300
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002698
Orphan claim re-pointed
Claims processor
CLM-402802 → UHC-56451-68 (Kimberly Rios)
Member id
UHC-56451-68
Confidence
1
Method
probabilistic
MBR-030597CLM-402802
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002699
Orphan claim re-pointed
Claims processor
CLM-403067 → UHC-67952-99 (Alexis Garza)
Member id
UHC-67952-99
Confidence
1
Method
probabilistic
MBR-015676CLM-403067
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002700
Orphan claim re-pointed
Claims processor
CLM-423662 → UHC-58068-44 (Bobby Luna)
Member id
UHC-58068-44
Confidence
1
Method
probabilistic
MBR-019073CLM-423662
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002701
Orphan claim re-pointed
Claims processor
CLM-416134 → UHC-67936-93 (Emma Park)
Member id
UHC-67936-93
Confidence
0.99
Method
probabilistic
MBR-010195CLM-416134
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002702
Orphan claim re-pointed
Claims processor
CLM-425320 → UHC-95632-60 (Gerald Russell)
Member id
UHC-95632-60
Confidence
1
Method
probabilistic
MBR-000568CLM-425320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002703
Orphan claim re-pointed
Claims processor
CLM-414682 → UHC-78624-36 (Edward Chapman)
Member id
UHC-78624-36
Confidence
1
Method
probabilistic
MBR-025617CLM-414682
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002704
Orphan claim re-pointed
Claims processor
CLM-407664 → UHC-74632-47 (Christopher Bowman)
Member id
UHC-74632-47
Confidence
0.97
Method
deterministic
MBR-008362CLM-407664
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002705
Orphan claim re-pointed
Claims processor
CLM-430833 → UHC-52083-96 (Jesse Kim)
Member id
UHC-52083-96
Confidence
1
Method
probabilistic
MBR-004548CLM-430833
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002706
Orphan claim re-pointed
Claims processor
CLM-407087 → UHC-44422-88 (Ralph Daniels)
Member id
UHC-44422-88
Confidence
1
Method
probabilistic
MBR-000036CLM-407087
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002707
Orphan claim re-pointed
Claims processor
CLM-401259 → UHC-59285-16 (Nancy Delgado)
Member id
UHC-59285-16
Confidence
1
Method
probabilistic
MBR-003675CLM-401259
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002708
Orphan claim re-pointed
Claims processor
CLM-417345 → UHC-37551-83 (Ana Mason)
Member id
UHC-37551-83
Confidence
1
Method
probabilistic
MBR-020341CLM-417345
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002709
Orphan claim re-pointed
Claims processor
CLM-404809 → UHC-63795-99 (Michelle Fowler)
Member id
UHC-63795-99
Confidence
1
Method
probabilistic
MBR-028157CLM-404809
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002710
Orphan claim re-pointed
Claims processor
CLM-411743 → UHC-34549-49 (Albert Guzman)
Member id
UHC-34549-49
Confidence
0.94
Method
probabilistic
MBR-022651CLM-411743
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002711
Orphan claim re-pointed
Claims processor
CLM-419359 → UHC-61304-66 (Samantha Burns)
Member id
UHC-61304-66
Confidence
1
Method
probabilistic
MBR-028093CLM-419359
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 192 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.