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-003512 | Orphan claim re-pointed Claims processor | CLM-417829 → UHC-66935-98 (Ashley Bradley) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003513 | Orphan claim re-pointed Claims processor | CLM-422880 → UHC-10931-15 (Jonathan Kelly) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003514 | Orphan claim re-pointed Claims processor | CLM-405592 → UHC-39876-62 (Rachel Hansen) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003515 | Orphan claim re-pointed Claims processor | CLM-406575 → UHC-26825-50 (Justin Cooper) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003516 | Orphan claim re-pointed Claims processor | CLM-413953 → UHC-28639-46 (Joyce Reyes) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003517 | Orphan claim re-pointed Claims processor | CLM-416087 → UHC-07850-72 (Sean Walsh) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003518 | Orphan claim re-pointed Claims processor | CLM-415753 → UHC-27869-19 (Christine Roberts) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003519 | Orphan claim re-pointed Claims processor | CLM-416318 → UHC-69287-28 (Samantha Graham) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003520 | Orphan claim re-pointed Claims processor | CLM-431265 → UHC-95083-87 (Thomas Luna) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003521 | Orphan claim re-pointed Claims processor | CLM-406217 → UHC-73728-14 (Frank Armstrong) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003522 | Orphan claim re-pointed Claims processor | CLM-430361 → UHC-39140-72 (Mariana Garrett) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003523 | Orphan claim re-pointed Claims processor | CLM-401388 → UHC-99603-38 (Scott Evans) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003524 | Orphan claim re-pointed Claims processor | CLM-414750 → UHC-13601-93 (Juan Lopez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003525 | Orphan claim re-pointed Claims processor | CLM-404595 → UHC-13136-66 (Amber Mejia) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003526 | Orphan claim re-pointed Claims processor | CLM-416843 → UHC-80412-20 (Aaron Castillo) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003527 | Orphan claim re-pointed Claims processor | CLM-421944 → UHC-83412-14 (Douglas Soto) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003528 | Orphan claim re-pointed Claims processor | CLM-419114 → UHC-74605-10 (Graace Mendez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003529 | Orphan claim re-pointed Claims processor | CLM-420909 → UHC-05548-92 (Michelle Carpenter) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003530 | Orphan claim re-pointed Claims processor | CLM-405824 → UHC-73667-01 (Carolyn Luna) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003531 | Orphan claim re-pointed Claims processor | CLM-424093 → UHC-37073-66 (Nicole Gonzalez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003532 | Orphan claim re-pointed Claims processor | CLM-402569 → UHC-53180-13 (Andrew Cox) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003533 | Orphan claim re-pointed Claims processor | CLM-425065 → UHC-66989-30 (Terry Watson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003534 | Orphan claim re-pointed Claims processor | CLM-430223 → UHC-85289-63 (Jaince Hawkins) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003535 | Orphan claim re-pointed Claims processor | CLM-400216 → UHC-17817-28 (Harold Pena) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003536 | Orphan claim re-pointed Claims processor | CLM-414916 → UHC-32027-99 (Andrea Pena) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003537 | Orphan claim re-pointed Claims processor | CLM-407026 → UHC-68285-69 (Andrew Woods) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003538 | Orphan claim re-pointed Claims processor | CLM-415122 → UHC-96249-54 (Timothy Brooks) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003539 | Orphan claim re-pointed Claims processor | CLM-427410 → UHC-82962-29 (Gloria Ward) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003540 | Orphan claim re-pointed Claims processor | CLM-419531 → UHC-22772-73 (Jessica Young) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003541 | Orphan claim re-pointed Claims processor | CLM-431370 → UHC-41025-03 (William Collins) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003542 | Orphan claim re-pointed Claims processor | CLM-422721 → UHC-44775-27 (Roger Ortega) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003543 | Orphan claim re-pointed Claims processor | CLM-410587 → UHC-39136-20 (Judy Franklin) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003544 | Orphan claim re-pointed Claims processor | CLM-410102 → UHC-71809-10 (Rebecca Schultz) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003545 | Orphan claim re-pointed Claims processor | CLM-403518 → UHC-82338-95 (Luis Richards) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003546 | Orphan claim re-pointed Claims processor | CLM-411645 → UHC-09877-57 (Jonathan Ortega) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003547 | Orphan claim re-pointed Claims processor | CLM-422691 → UHC-26774-18 (Richard Santiago) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003548 | Orphan claim re-pointed Claims processor | CLM-400821 → UHC-65216-04 (Albert Hanson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003549 | Orphan claim re-pointed Claims processor | CLM-405704 → UHC-77190-83 (Abigail Little) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003550 | Orphan claim re-pointed Claims processor | CLM-420287 → UHC-61742-56 (Kevin Mejia) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003551 | Orphan claim re-pointed Claims processor | CLM-400660 → UHC-86290-04 (Ashley Brown) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003552 | Orphan claim re-pointed Claims processor | CLM-403654 → UHC-42261-80 (Kyle Salazar) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003553 | Orphan claim re-pointed Claims processor | CLM-403065 → UHC-59619-27 (Terry Lane) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003554 | Orphan claim re-pointed Claims processor | CLM-417229 → UHC-88955-23 (Andrea Anderson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003555 | Orphan claim re-pointed Claims processor | CLM-417802 → UHC-50434-74 (Gloria Crawford) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003556 | Orphan claim re-pointed Claims processor | CLM-426640 → UHC-70984-66 (Kelly Lawrence) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003557 | Orphan claim re-pointed Claims processor | CLM-419945 → UHC-60747-77 (Robert Price) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003558 | Orphan claim re-pointed Claims processor | CLM-428108 → UHC-55649-52 (Daniels Arjun) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003559 | Orphan claim re-pointed Claims processor | CLM-413271 → UHC-96133-18 (Grace Maldonado) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003560 | Orphan claim re-pointed Claims processor | CLM-431682 → UHC-20252-42 (Terry Boyd) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-003561 | Orphan claim re-pointed Claims processor | CLM-426797 → UHC-60300-25 (Cheryl Walker) |
| 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.