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-002290
Orphan claim re-pointed
Claims processor
CLM-402391 → UHC-47202-05 (Justin Ross)
Member id
UHC-47202-05
Confidence
0.93
Method
probabilistic
MBR-027023CLM-402391
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002291
Orphan claim re-pointed
Claims processor
CLM-430979 → UHC-47494-97 (Karen Thomas)
Member id
UHC-47494-97
Confidence
1
Method
probabilistic
MBR-018889CLM-430979
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002292
Orphan claim re-pointed
Claims processor
CLM-427173 → UHC-11439-98 (Bryan Black)
Member id
UHC-11439-98
Confidence
1
Method
probabilistic
MBR-003456CLM-427173
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002293
Orphan claim re-pointed
Claims processor
CLM-426667 → UHC-71604-82 (Ana Lee)
Member id
UHC-71604-82
Confidence
1
Method
probabilistic
MBR-031901CLM-426667
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002294
Orphan claim re-pointed
Claims processor
CLM-424889 → UHC-61480-16 (Aishha Moore)
Member id
UHC-61480-16
Confidence
0.99
Method
probabilistic
MBR-041296CLM-424889
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002295
Orphan claim re-pointed
Claims processor
CLM-408669 → UHC-47109-24 (Ruth Fisher)
Member id
UHC-47109-24
Confidence
1
Method
probabilistic
MBR-006286CLM-408669
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002296
Orphan claim re-pointed
Claims processor
CLM-413554 → UHC-81029-42 (Deborah Rose)
Member id
UHC-81029-42
Confidence
1
Method
probabilistic
MBR-000020CLM-413554
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002297
Orphan claim re-pointed
Claims processor
CLM-404227 → UHC-38360-46 (Jean Gonzales)
Member id
UHC-38360-46
Confidence
1
Method
probabilistic
MBR-000195CLM-404227
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002298
Orphan claim re-pointed
Claims processor
CLM-403609 → UHC-77954-08 (Robert Jordan)
Member id
UHC-77954-08
Confidence
1
Method
probabilistic
MBR-008675CLM-403609
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002299
Orphan claim re-pointed
Claims processor
CLM-423092 → UHC-11916-11 (Amber Watkins)
Member id
UHC-11916-11
Confidence
1
Method
probabilistic
MBR-009897CLM-423092
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002300
Orphan claim re-pointed
Claims processor
CLM-405069 → UHC-72077-72 (Alan Aguilar)
Member id
UHC-72077-72
Confidence
1
Method
probabilistic
MBR-003249CLM-405069
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002301
Orphan claim re-pointed
Claims processor
CLM-401948 → UHC-41084-85 (Ralph Perry)
Member id
UHC-41084-85
Confidence
1
Method
probabilistic
MBR-034385CLM-401948
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002302
Orphan claim re-pointed
Claims processor
CLM-423765 → UHC-74068-29 (Margaret Stevens)
Member id
UHC-74068-29
Confidence
0.97
Method
deterministic
MBR-011123CLM-423765
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002303
Orphan claim re-pointed
Claims processor
CLM-400967 → UHC-99845-01 (Joseph Gilbert)
Member id
UHC-99845-01
Confidence
0.99
Method
probabilistic
MBR-025011CLM-400967
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002304
Orphan claim re-pointed
Claims processor
CLM-424895 → UHC-23833-14 (Frank Roberts)
Member id
UHC-23833-14
Confidence
1
Method
probabilistic
MBR-017735CLM-424895
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002305
Orphan claim re-pointed
Claims processor
CLM-405450 → UHC-99272-28 (Jacob McDonald)
Member id
UHC-99272-28
Confidence
1
Method
probabilistic
MBR-006548CLM-405450
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002306
Orphan claim re-pointed
Claims processor
CLM-400398 → UHC-54640-63 (Shirley Watson)
Member id
UHC-54640-63
Confidence
0.99
Method
probabilistic
MBR-024323CLM-400398
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002307
Orphan claim re-pointed
Claims processor
CLM-412938 → UHC-56397-77 (Emma Dunn)
Member id
UHC-56397-77
Confidence
0.97
Method
deterministic
MBR-013400CLM-412938
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002308
Orphan claim re-pointed
Claims processor
CLM-424382 → UHC-28200-70 (Richard Chapman)
Member id
UHC-28200-70
Confidence
0.97
Method
deterministic
MBR-014158CLM-424382
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002309
Orphan claim re-pointed
Claims processor
CLM-415273 → UHC-94929-40 (Kimberly Marquez)
Member id
UHC-94929-40
Confidence
0.97
Method
deterministic
MBR-000016CLM-415273
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002310
Orphan claim re-pointed
Claims processor
CLM-420571 → UHC-70228-56 (Linda McDonald)
Member id
UHC-70228-56
Confidence
1
Method
probabilistic
MBR-013007CLM-420571
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002311
Orphan claim re-pointed
Claims processor
CLM-428232 → UHC-45079-43 (Jerry Dunn)
Member id
UHC-45079-43
Confidence
1
Method
probabilistic
MBR-006905CLM-428232
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002312
Orphan claim re-pointed
Claims processor
CLM-407330 → UHC-05201-04 (Willie Harrison)
Member id
UHC-05201-04
Confidence
1
Method
probabilistic
MBR-017884CLM-407330
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002313
Orphan claim re-pointed
Claims processor
CLM-427520 → UHC-98167-09 (Albert Flores)
Member id
UHC-98167-09
Confidence
0.86
Method
probabilistic
MBR-031396CLM-427520
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002314
Orphan claim re-pointed
Claims processor
CLM-415640 → UHC-85530-87 (Ronald Fuller)
Member id
UHC-85530-87
Confidence
1
Method
probabilistic
MBR-008627CLM-415640
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002315
Orphan claim re-pointed
Claims processor
CLM-401744 → UHC-06356-65 (Bradley Rice)
Member id
UHC-06356-65
Confidence
1
Method
probabilistic
MBR-027357CLM-401744
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002316
Orphan claim re-pointed
Claims processor
CLM-417771 → UHC-16715-78 (Amy Larson)
Member id
UHC-16715-78
Confidence
1
Method
probabilistic
MBR-006625CLM-417771
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002317
Orphan claim re-pointed
Claims processor
CLM-405598 → UHC-90677-97 (Mason Herrera)
Member id
UHC-90677-97
Confidence
0.94
Method
probabilistic
MBR-038032CLM-405598
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002318
Orphan claim re-pointed
Claims processor
CLM-428897 → UHC-33334-49 (Brittany Griffin)
Member id
UHC-33334-49
Confidence
1
Method
probabilistic
MBR-023459CLM-428897
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002319
Orphan claim re-pointed
Claims processor
CLM-416861 → UHC-21154-82 (David Chapman)
Member id
UHC-21154-82
Confidence
1
Method
probabilistic
MBR-033510CLM-416861
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002320
Orphan claim re-pointed
Claims processor
CLM-404082 → UHC-64825-97 (Ana Fuller)
Member id
UHC-64825-97
Confidence
1
Method
probabilistic
MBR-018940CLM-404082
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002321
Orphan claim re-pointed
Claims processor
CLM-416180 → UHC-37217-39 (Thomas Lawrence)
Member id
UHC-37217-39
Confidence
1
Method
probabilistic
MBR-004682CLM-416180
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002322
Orphan claim re-pointed
Claims processor
CLM-409910 → UHC-84332-87 (Jordan Fowler)
Member id
UHC-84332-87
Confidence
1
Method
probabilistic
MBR-003834CLM-409910
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002323
Orphan claim re-pointed
Claims processor
CLM-427859 → UHC-70759-17 (Bradley Hernandez)
Member id
UHC-70759-17
Confidence
1
Method
probabilistic
MBR-021886CLM-427859
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002324
Orphan claim re-pointed
Claims processor
CLM-424939 → UHC-82777-29 (Diane Flores)
Member id
UHC-82777-29
Confidence
1
Method
probabilistic
MBR-011528CLM-424939
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002325
Orphan claim re-pointed
Claims processor
CLM-405167 → UHC-12186-67 (Richard Hudson)
Member id
UHC-12186-67
Confidence
1
Method
probabilistic
MBR-003424CLM-405167
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002326
Orphan claim re-pointed
Claims processor
CLM-426056 → UHC-28432-36 (Ruth Peez)
Member id
UHC-28432-36
Confidence
0.97
Method
deterministic
MBR-002865CLM-426056
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002327
Orphan claim re-pointed
Claims processor
CLM-415958 → UHC-59669-36 (Joan Lee)
Member id
UHC-59669-36
Confidence
1
Method
probabilistic
MBR-040747CLM-415958
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002328
Orphan claim re-pointed
Claims processor
CLM-406232 → UHC-00189-24 (Victoria Schmidt)
Member id
UHC-00189-24
Confidence
1
Method
probabilistic
MBR-010443CLM-406232
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002329
Orphan claim re-pointed
Claims processor
CLM-413560 → UHC-46150-37 (Cheryl Ward)
Member id
UHC-46150-37
Confidence
0.97
Method
deterministic
MBR-020227CLM-413560
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002330
Orphan claim re-pointed
Claims processor
CLM-409045 → UHC-09446-73 (Doris Ford)
Member id
UHC-09446-73
Confidence
0.99
Method
probabilistic
MBR-019908CLM-409045
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002331
Orphan claim re-pointed
Claims processor
CLM-417022 → UHC-08427-88 (Peter Arnold)
Member id
UHC-08427-88
Confidence
0.97
Method
deterministic
MBR-029654CLM-417022
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002332
Orphan claim re-pointed
Claims processor
CLM-423300 → UHC-37027-49 (Sofia Silva)
Member id
UHC-37027-49
Confidence
1
Method
probabilistic
MBR-035610CLM-423300
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002333
Orphan claim re-pointed
Claims processor
CLM-427393 → UHC-15905-97 (Madison Reyes)
Member id
UHC-15905-97
Confidence
0.98
Method
probabilistic
MBR-007893CLM-427393
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002334
Orphan claim re-pointed
Claims processor
CLM-411375 → UHC-85505-93 (Heather Garza)
Member id
UHC-85505-93
Confidence
1
Method
probabilistic
MBR-026564CLM-411375
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002335
Orphan claim re-pointed
Claims processor
CLM-421864 → UHC-92156-95 (Harold Rivera)
Member id
UHC-92156-95
Confidence
1
Method
probabilistic
MBR-005769CLM-421864
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002336
Orphan claim re-pointed
Claims processor
CLM-404972 → UHC-78928-58 (Don Elliott)
Member id
UHC-78928-58
Confidence
1
Method
probabilistic
MBR-013229CLM-404972
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002337
Orphan claim re-pointed
Claims processor
CLM-415166 → UHC-08541-87 (Daniel Hunter)
Member id
UHC-08541-87
Confidence
1
Method
probabilistic
MBR-017826CLM-415166
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002338
Orphan claim re-pointed
Claims processor
CLM-418811 → UHC-55168-96 (Alice Vazquez)
Member id
UHC-55168-96
Confidence
1
Method
probabilistic
MBR-010889CLM-418811
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002339
Orphan claim re-pointed
Claims processor
CLM-401938 → UHC-26954-37 (Katherine Montgomery)
Member id
UHC-26954-37
Confidence
1
Method
probabilistic
MBR-024576CLM-401938
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 20 of 282PreviousNext

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.