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-003612
Orphan claim re-pointed
Claims processor
CLM-413891 → UHC-98772-34 (Julia Cunningham)
Member id
UHC-98772-34
Confidence
1
Method
probabilistic
MBR-018814CLM-413891
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003613
Orphan claim re-pointed
Claims processor
CLM-417734 → UHC-17167-67 (Wayne Garza)
Member id
UHC-17167-67
Confidence
1
Method
probabilistic
MBR-002008CLM-417734
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003614
Orphan claim re-pointed
Claims processor
CLM-417552 → UHC-10019-54 (Albert Cruz)
Member id
UHC-10019-54
Confidence
0.86
Method
probabilistic
MBR-023958CLM-417552
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003615
Orphan claim re-pointed
Claims processor
CLM-428511 → UHC-54516-18 (Hannah Nelson)
Member id
UHC-54516-18
Confidence
1
Method
probabilistic
MBR-002099CLM-428511
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003616
Orphan claim re-pointed
Claims processor
CLM-406695 → UHC-65859-51 (Deborah Reyes)
Member id
UHC-65859-51
Confidence
1
Method
probabilistic
MBR-021494CLM-406695
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003617
Orphan claim re-pointed
Claims processor
CLM-403150 → UHC-95688-46 (Diego Jones)
Member id
UHC-95688-46
Confidence
0.97
Method
deterministic
MBR-019542CLM-403150
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003618
Orphan claim re-pointed
Claims processor
CLM-414917 → UHC-86231-01 (Christina Wilson)
Member id
UHC-86231-01
Confidence
1
Method
probabilistic
MBR-026654CLM-414917
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003619
Orphan claim re-pointed
Claims processor
CLM-421162 → UHC-43377-08 (Teresa Harrison)
Member id
UHC-43377-08
Confidence
0.97
Method
deterministic
MBR-010702CLM-421162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003620
Orphan claim re-pointed
Claims processor
CLM-422214 → UHC-15396-79 (Diana Spencer)
Member id
UHC-15396-79
Confidence
1
Method
probabilistic
MBR-009491CLM-422214
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003621
Orphan claim re-pointed
Claims processor
CLM-420944 → UHC-91116-58 (Russell Bell)
Member id
UHC-91116-58
Confidence
1
Method
probabilistic
MBR-008996CLM-420944
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003622
Orphan claim re-pointed
Claims processor
CLM-429647 → UHC-45864-37 (Kenneth Cox)
Member id
UHC-45864-37
Confidence
1.00
Method
probabilistic
MBR-009973CLM-429647
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003623
Orphan claim re-pointed
Claims processor
CLM-416853 → UHC-75899-09 (Jean Collins)
Member id
UHC-75899-09
Confidence
0.97
Method
deterministic
MBR-003447CLM-416853
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003624
Orphan claim re-pointed
Claims processor
CLM-413923 → UHC-11042-41 (Anthony Silva)
Member id
UHC-11042-41
Confidence
0.97
Method
deterministic
MBR-039778CLM-413923
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003625
Orphan claim re-pointed
Claims processor
CLM-415218 → UHC-44164-95 (Richard Johnson)
Member id
UHC-44164-95
Confidence
1
Method
probabilistic
MBR-002896CLM-415218
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003626
Orphan claim re-pointed
Claims processor
CLM-421090 → UHC-58798-14 (David Butler)
Member id
UHC-58798-14
Confidence
0.99
Method
probabilistic
MBR-005597CLM-421090
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003627
Orphan claim re-pointed
Claims processor
CLM-411404 → UHC-39812-09 (Emma Harrison)
Member id
UHC-39812-09
Confidence
1
Method
probabilistic
MBR-002130CLM-411404
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003628
Orphan claim re-pointed
Claims processor
CLM-430629 → UHC-77280-77 (Barbara Stevens)
Member id
UHC-77280-77
Confidence
1
Method
probabilistic
MBR-033963CLM-430629
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003629
Orphan claim re-pointed
Claims processor
CLM-404689 → UHC-45993-85 (Ashley Bowman)
Member id
UHC-45993-85
Confidence
1
Method
probabilistic
MBR-006306CLM-404689
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003630
Orphan claim re-pointed
Claims processor
CLM-431154 → UHC-80704-58 (Patrick Rios)
Member id
UHC-80704-58
Confidence
0.97
Method
deterministic
MBR-003721CLM-431154
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003631
Orphan claim re-pointed
Claims processor
CLM-430248 → UHC-10245-84 (Russell Matthews)
Member id
UHC-10245-84
Confidence
0.97
Method
deterministic
MBR-026283CLM-430248
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003632
Orphan claim re-pointed
Claims processor
CLM-421460 → UHC-10409-87 (Samantha Ray)
Member id
UHC-10409-87
Confidence
1
Method
probabilistic
MBR-003854CLM-421460
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003633
Orphan claim re-pointed
Claims processor
CLM-403986 → UHC-32919-73 (Jennifer Schmidt)
Member id
UHC-32919-73
Confidence
1
Method
probabilistic
MBR-028449CLM-403986
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003634
Orphan claim re-pointed
Claims processor
CLM-429182 → UHC-31006-11 (Megan Richardson)
Member id
UHC-31006-11
Confidence
0.97
Method
deterministic
MBR-020039CLM-429182
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003635
Orphan claim re-pointed
Claims processor
CLM-404973 → UHC-95807-32 (Aaron Mendez)
Member id
UHC-95807-32
Confidence
1
Method
probabilistic
MBR-015318CLM-404973
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003636
Orphan claim re-pointed
Claims processor
CLM-414187 → UHC-16639-21 (Sarah Bennett)
Member id
UHC-16639-21
Confidence
1
Method
probabilistic
MBR-018629CLM-414187
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003637
Orphan claim re-pointed
Claims processor
CLM-413459 → UHC-86002-96 (Jason Johnston)
Member id
UHC-86002-96
Confidence
1
Method
probabilistic
MBR-018090CLM-413459
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003638
Orphan claim re-pointed
Claims processor
CLM-430963 → UHC-19301-15 (Luis Butler)
Member id
UHC-19301-15
Confidence
0.97
Method
deterministic
MBR-017198CLM-430963
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003639
Orphan claim re-pointed
Claims processor
CLM-406708 → UHC-09499-92 (Mariana Ortega)
Member id
UHC-09499-92
Confidence
0.97
Method
deterministic
MBR-019202CLM-406708
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003640
Orphan claim re-pointed
Claims processor
CLM-432759 → UHC-82685-52 (Randy Nunez)
Member id
UHC-82685-52
Confidence
1
Method
probabilistic
MBR-042589CLM-432759
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003641
Orphan claim re-pointed
Claims processor
CLM-410499 → UHC-93692-17 (Isabella Ramirez)
Member id
UHC-93692-17
Confidence
1
Method
probabilistic
MBR-031437CLM-410499
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003642
Orphan claim re-pointed
Claims processor
CLM-412023 → UHC-91736-60 (Randy Sims)
Member id
UHC-91736-60
Confidence
1
Method
probabilistic
MBR-012073CLM-412023
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003643
Orphan claim re-pointed
Claims processor
CLM-427697 → UHC-53069-38 (Billy Henderson)
Member id
UHC-53069-38
Confidence
1
Method
probabilistic
MBR-002934CLM-427697
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003644
Orphan claim re-pointed
Claims processor
CLM-408604 → UHC-10171-50 (Robert Palmer)
Member id
UHC-10171-50
Confidence
0.97
Method
deterministic
MBR-001934CLM-408604
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003645
Orphan claim re-pointed
Claims processor
CLM-404533 → UHC-53774-63 (Hiroshi Kelley)
Member id
UHC-53774-63
Confidence
1
Method
probabilistic
MBR-022485CLM-404533
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003646
Orphan claim re-pointed
Claims processor
CLM-415101 → UHC-24537-63 (Michelle Lee)
Member id
UHC-24537-63
Confidence
0.93
Method
probabilistic
MBR-019450CLM-415101
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003647
Orphan claim re-pointed
Claims processor
CLM-405483 → UHC-96934-23 (Thomas Powell)
Member id
UHC-96934-23
Confidence
1
Method
probabilistic
MBR-019887CLM-405483
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003648
Orphan claim re-pointed
Claims processor
CLM-420815 → UHC-62165-37 (Alexander Harris)
Member id
UHC-62165-37
Confidence
0.97
Method
deterministic
MBR-024086CLM-420815
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003649
Orphan claim re-pointed
Claims processor
CLM-421897 → UHC-32702-07 (Martha Watson)
Member id
UHC-32702-07
Confidence
0.93
Method
probabilistic
MBR-020296CLM-421897
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003650
Orphan claim re-pointed
Claims processor
CLM-402249 → UHC-27907-28 (Charlotte Alvarez)
Member id
UHC-27907-28
Confidence
1
Method
probabilistic
MBR-034019CLM-402249
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003651
Orphan claim re-pointed
Claims processor
CLM-422591 → UHC-73740-43 (Julie Ryan)
Member id
UHC-73740-43
Confidence
0.97
Method
deterministic
MBR-011723CLM-422591
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003652
Orphan claim re-pointed
Claims processor
CLM-414483 → UHC-36583-04 (Joan Torres)
Member id
UHC-36583-04
Confidence
0.99
Method
probabilistic
MBR-006817CLM-414483
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003653
Orphan claim re-pointed
Claims processor
CLM-404782 → UHC-06843-43 (Mateo Jensen)
Member id
UHC-06843-43
Confidence
1
Method
probabilistic
MBR-037366CLM-404782
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003654
Orphan claim re-pointed
Claims processor
CLM-409622 → UHC-67568-05 (Larry Moore)
Member id
UHC-67568-05
Confidence
0.97
Method
deterministic
MBR-005293CLM-409622
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003655
Orphan claim re-pointed
Claims processor
CLM-424788 → UHC-30287-02 (Camila Coleman)
Member id
UHC-30287-02
Confidence
1
Method
probabilistic
MBR-000095CLM-424788
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003656
Orphan claim re-pointed
Claims processor
CLM-421432 → UHC-17147-62 (Lucia Vazquez)
Member id
UHC-17147-62
Confidence
1
Method
probabilistic
MBR-031282CLM-421432
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003657
Orphan claim re-pointed
Claims processor
CLM-425631 → UHC-08115-31 (Emily Dunn)
Member id
UHC-08115-31
Confidence
1
Method
probabilistic
MBR-005095CLM-425631
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003658
Orphan claim re-pointed
Claims processor
CLM-422605 → UHC-33618-37 (Dylan Ramos)
Member id
UHC-33618-37
Confidence
1
Method
probabilistic
MBR-015610CLM-422605
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003659
Orphan claim re-pointed
Claims processor
CLM-423888 → UHC-91198-73 (Judy Montgomery)
Member id
UHC-91198-73
Confidence
1
Method
probabilistic
MBR-004286CLM-423888
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003660
Orphan claim re-pointed
Claims processor
CLM-422023 → UHC-79280-23 (Ryan Edwards)
Member id
UHC-79280-23
Confidence
1
Method
probabilistic
MBR-006135CLM-422023
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003661
Orphan claim re-pointed
Claims processor
CLM-428836 → UHC-77677-08 (Ashley Walsh)
Member id
UHC-77677-08
Confidence
0.93
Method
probabilistic
MBR-013463CLM-428836
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 211 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.