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
Orphan claim re-pointed, Claims processor, 0 proposed
ActionTypeTitleDetailLinked toStatusExecuted
ACT-001390
Orphan claim re-pointed
Claims processor
CLM-425378 → UHC-65487-82 (Philip Tucker)
Member id
UHC-65487-82
Confidence
0.98
Method
probabilistic
MBR-001743CLM-425378
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001391
Orphan claim re-pointed
Claims processor
CLM-420679 → UHC-21383-58 (Davis Deborah)
Member id
UHC-21383-58
Confidence
0.99
Method
probabilistic
MBR-007859CLM-420679
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001392
Orphan claim re-pointed
Claims processor
CLM-412033 → UHC-80619-64 (Samuel Wong)
Member id
UHC-80619-64
Confidence
0.97
Method
deterministic
MBR-027661CLM-412033
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001393
Orphan claim re-pointed
Claims processor
CLM-432325 → UHC-22950-87 (Ruth Allen)
Member id
UHC-22950-87
Confidence
1
Method
probabilistic
MBR-026887CLM-432325
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001394
Orphan claim re-pointed
Claims processor
CLM-420751 → UHC-97448-63 (Cheryl Owens)
Member id
UHC-97448-63
Confidence
0.99
Method
probabilistic
MBR-014030CLM-420751
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001395
Orphan claim re-pointed
Claims processor
CLM-430778 → UHC-14259-82 (Katherine Wheeler)
Member id
UHC-14259-82
Confidence
1
Method
probabilistic
MBR-006551CLM-430778
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001396
Orphan claim re-pointed
Claims processor
CLM-424081 → UHC-77158-63 (Aaron Holmes)
Member id
UHC-77158-63
Confidence
1
Method
probabilistic
MBR-011632CLM-424081
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001397
Orphan claim re-pointed
Claims processor
CLM-429999 → UHC-04417-79 (Daniel Russell)
Member id
UHC-04417-79
Confidence
0.99
Method
probabilistic
MBR-005035CLM-429999
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001398
Orphan claim re-pointed
Claims processor
CLM-406486 → UHC-47566-06 (Ralph Schultz)
Member id
UHC-47566-06
Confidence
0.93
Method
probabilistic
MBR-017855CLM-406486
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001399
Orphan claim re-pointed
Claims processor
CLM-420956 → UHC-08680-52 (Brian Harrison)
Member id
UHC-08680-52
Confidence
0.94
Method
probabilistic
MBR-033431CLM-420956
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001400
Orphan claim re-pointed
Claims processor
CLM-426687 → UHC-49985-38 (Frances Ross)
Member id
UHC-49985-38
Confidence
0.97
Method
deterministic
MBR-018682CLM-426687
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001401
Orphan claim re-pointed
Claims processor
CLM-415107 → UHC-64207-18 (Emma White)
Member id
UHC-64207-18
Confidence
0.97
Method
deterministic
MBR-034494CLM-415107
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001402
Orphan claim re-pointed
Claims processor
CLM-409359 → UHC-34135-53 (Susan Scott)
Member id
UHC-34135-53
Confidence
1
Method
probabilistic
MBR-041635CLM-409359
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001403
Orphan claim re-pointed
Claims processor
CLM-407126 → UHC-63084-83 (Valentina Wheeler)
Member id
UHC-63084-83
Confidence
0.93
Method
probabilistic
MBR-009309CLM-407126
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001404
Orphan claim re-pointed
Claims processor
CLM-428226 → UHC-66979-80 (Joan Vazquez)
Member id
UHC-66979-80
Confidence
1
Method
probabilistic
MBR-021172CLM-428226
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001405
Orphan claim re-pointed
Claims processor
CLM-417452 → UHC-11876-86 (Rachel Webb)
Member id
UHC-11876-86
Confidence
1
Method
probabilistic
MBR-022101CLM-417452
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001406
Orphan claim re-pointed
Claims processor
CLM-427901 → UHC-83530-31 (Keith Larson)
Member id
UHC-83530-31
Confidence
1
Method
probabilistic
MBR-008957CLM-427901
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001407
Orphan claim re-pointed
Claims processor
CLM-413519 → UHC-29020-28 (Richard Boyd)
Member id
UHC-29020-28
Confidence
0.97
Method
deterministic
MBR-018613CLM-413519
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001408
Orphan claim re-pointed
Claims processor
CLM-413625 → UHC-21997-61 (Eric Sullivan)
Member id
UHC-21997-61
Confidence
1
Method
probabilistic
MBR-010955CLM-413625
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001409
Orphan claim re-pointed
Claims processor
CLM-404032 → UHC-10810-94 (Kyle Simpson)
Member id
UHC-10810-94
Confidence
0.97
Method
deterministic
MBR-027999CLM-404032
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001410
Orphan claim re-pointed
Claims processor
CLM-412954 → UHC-34219-67 (Rachel Diaz)
Member id
UHC-34219-67
Confidence
1
Method
probabilistic
MBR-001784CLM-412954
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001411
Orphan claim re-pointed
Claims processor
CLM-409018 → UHC-99969-24 (Arjun Flores)
Member id
UHC-99969-24
Confidence
1
Method
probabilistic
MBR-003329CLM-409018
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001412
Orphan claim re-pointed
Claims processor
CLM-413269 → UHC-33504-82 (Laura Gonzalez)
Member id
UHC-33504-82
Confidence
1
Method
probabilistic
MBR-022868CLM-413269
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001413
Orphan claim re-pointed
Claims processor
CLM-426158 → UHC-53548-27 (Roy Watson)
Member id
UHC-53548-27
Confidence
1
Method
probabilistic
MBR-020720CLM-426158
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001414
Orphan claim re-pointed
Claims processor
CLM-428579 → UHC-89148-48 (Ana Jimenez)
Member id
UHC-89148-48
Confidence
1
Method
probabilistic
MBR-016255CLM-428579
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001415
Orphan claim re-pointed
Claims processor
CLM-426562 → UHC-77048-48 (Scott Robertson)
Member id
UHC-77048-48
Confidence
1
Method
probabilistic
MBR-009205CLM-426562
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001416
Orphan claim re-pointed
Claims processor
CLM-414872 → UHC-90127-83 (Elizabeth George)
Member id
UHC-90127-83
Confidence
1
Method
probabilistic
MBR-022940CLM-414872
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001417
Orphan claim re-pointed
Claims processor
CLM-429527 → UHC-29333-35 (Frances Bryant)
Member id
UHC-29333-35
Confidence
1
Method
probabilistic
MBR-020619CLM-429527
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001418
Orphan claim re-pointed
Claims processor
CLM-412345 → UHC-53627-10 (Frances Harvey)
Member id
UHC-53627-10
Confidence
1
Method
probabilistic
MBR-014197CLM-412345
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001419
Orphan claim re-pointed
Claims processor
CLM-425021 → UHC-39990-48 (Maria Henry)
Member id
UHC-39990-48
Confidence
1
Method
probabilistic
MBR-007393CLM-425021
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001420
Orphan claim re-pointed
Claims processor
CLM-417865 → UHC-29559-72 (Jacqueline Maldonado)
Member id
UHC-29559-72
Confidence
0.98
Method
probabilistic
MBR-022477CLM-417865
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001421
Orphan claim re-pointed
Claims processor
CLM-419195 → UHC-10163-44 (Bruce Santos)
Member id
UHC-10163-44
Confidence
1
Method
probabilistic
MBR-013252CLM-419195
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001422
Orphan claim re-pointed
Claims processor
CLM-405836 → UHC-04169-42 (Vincent Diaz)
Member id
UHC-04169-42
Confidence
0.97
Method
deterministic
MBR-019161CLM-405836
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001423
Orphan claim re-pointed
Claims processor
CLM-405095 → UHC-32928-11 (Valentina Alvarado)
Member id
UHC-32928-11
Confidence
1
Method
probabilistic
MBR-000385CLM-405095
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001424
Orphan claim re-pointed
Claims processor
CLM-425514 → UHC-18011-83 (Walter Morris)
Member id
UHC-18011-83
Confidence
0.99
Method
probabilistic
MBR-008626CLM-425514
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001425
Orphan claim re-pointed
Claims processor
CLM-415092 → UHC-18514-12 (Daniel Reid)
Member id
UHC-18514-12
Confidence
1
Method
probabilistic
MBR-007247CLM-415092
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001426
Orphan claim re-pointed
Claims processor
CLM-408551 → UHC-20476-18 (Mariana Anderson)
Member id
UHC-20476-18
Confidence
1
Method
probabilistic
MBR-007549CLM-408551
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001427
Orphan claim re-pointed
Claims processor
CLM-418604 → UHC-12777-98 (Cynthia Gray)
Member id
UHC-12777-98
Confidence
1
Method
probabilistic
MBR-011635CLM-418604
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001428
Orphan claim re-pointed
Claims processor
CLM-430483 → UHC-72655-13 (George Nelson)
Member id
UHC-72655-13
Confidence
0.97
Method
deterministic
MBR-007358CLM-430483
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001429
Orphan claim re-pointed
Claims processor
CLM-426023 → UHC-14666-69 (Dorothy Fisher)
Member id
UHC-14666-69
Confidence
0.97
Method
deterministic
MBR-021353CLM-426023
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001430
Orphan claim re-pointed
Claims processor
CLM-412049 → UHC-12730-25 (Kevin Johnston)
Member id
UHC-12730-25
Confidence
0.97
Method
deterministic
MBR-024170CLM-412049
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001431
Orphan claim re-pointed
Claims processor
CLM-407726 → UHC-23060-35 (Billy Hart)
Member id
UHC-23060-35
Confidence
0.97
Method
deterministic
MBR-027658CLM-407726
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001432
Orphan claim re-pointed
Claims processor
CLM-402410 → UHC-12831-60 (Debra Romero)
Member id
UHC-12831-60
Confidence
1
Method
probabilistic
MBR-003446CLM-402410
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001433
Orphan claim re-pointed
Claims processor
CLM-407681 → UHC-74416-41 (Megan Carr)
Member id
UHC-74416-41
Confidence
0.97
Method
deterministic
MBR-038835CLM-407681
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001434
Orphan claim re-pointed
Claims processor
CLM-405694 → UHC-71216-93 (Kenneth Medina)
Member id
UHC-71216-93
Confidence
0.99
Method
probabilistic
MBR-038498CLM-405694
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001435
Orphan claim re-pointed
Claims processor
CLM-416805 → UHC-34558-20 (Aaron Hernandez)
Member id
UHC-34558-20
Confidence
0.97
Method
deterministic
MBR-006809CLM-416805
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001436
Orphan claim re-pointed
Claims processor
CLM-420992 → UHC-96647-42 (Doris Gilbert)
Member id
UHC-96647-42
Confidence
1
Method
probabilistic
MBR-000815CLM-420992
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001437
Orphan claim re-pointed
Claims processor
CLM-429888 → UHC-34288-51 (Alan Olson)
Member id
UHC-34288-51
Confidence
1
Method
probabilistic
MBR-024112CLM-429888
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001438
Orphan claim re-pointed
Claims processor
CLM-430004 → UHC-11306-08 (Yuki Vasquez)
Member id
UHC-11306-08
Confidence
1
Method
probabilistic
MBR-010477CLM-430004
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001439
Orphan claim re-pointed
Claims processor
CLM-414891 → UHC-48337-47 (David Ryan)
Member id
UHC-48337-47
Confidence
0.98
Method
probabilistic
MBR-020233CLM-414891
Executed
resolution_agent
2026-10-19 19:54:39
9,112 rows, page 2 of 183PreviousNext

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.