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-003812
Orphan claim re-pointed
Claims processor
CLM-431901 → UHC-38371-52 (Margaret Fernandez)
Member id
UHC-38371-52
Confidence
0.97
Method
deterministic
MBR-014857CLM-431901
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003813
Orphan claim re-pointed
Claims processor
CLM-425706 → UHC-52231-59 (Ahmed Watkins)
Member id
UHC-52231-59
Confidence
1
Method
probabilistic
MBR-023453CLM-425706
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003814
Orphan claim re-pointed
Claims processor
CLM-430626 → UHC-76455-82 (Edward Hunt)
Member id
UHC-76455-82
Confidence
1
Method
probabilistic
MBR-016058CLM-430626
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003815
Orphan claim re-pointed
Claims processor
CLM-432469 → UHC-34320-97 (Aaron Salazar)
Member id
UHC-34320-97
Confidence
1
Method
probabilistic
MBR-018490CLM-432469
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003816
Orphan claim re-pointed
Claims processor
CLM-423907 → UHC-85849-89 (Maria Jenkins)
Member id
UHC-85849-89
Confidence
1
Method
probabilistic
MBR-013883CLM-423907
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003817
Orphan claim re-pointed
Claims processor
CLM-405725 → UHC-66409-87 (Frank Parker)
Member id
UHC-66409-87
Confidence
0.97
Method
deterministic
MBR-042094CLM-405725
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003818
Orphan claim re-pointed
Claims processor
CLM-424139 → UHC-07458-97 (Sofia Walker)
Member id
UHC-07458-97
Confidence
0.86
Method
probabilistic
MBR-002935CLM-424139
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003819
Orphan claim re-pointed
Claims processor
CLM-412511 → UHC-25407-01 (Kyle Jensen)
Member id
UHC-25407-01
Confidence
1
Method
probabilistic
MBR-019229CLM-412511
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003820
Orphan claim re-pointed
Claims processor
CLM-407285 → UHC-71067-71 (Carl Torres)
Member id
UHC-71067-71
Confidence
1
Method
probabilistic
MBR-041156CLM-407285
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003821
Orphan claim re-pointed
Claims processor
CLM-400047 → UHC-06704-09 (Sandra Rice)
Member id
UHC-06704-09
Confidence
1
Method
probabilistic
MBR-024266CLM-400047
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003822
Orphan claim re-pointed
Claims processor
CLM-416430 → UHC-70271-69 (Ann Luna)
Member id
UHC-70271-69
Confidence
1
Method
probabilistic
MBR-011889CLM-416430
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003823
Orphan claim re-pointed
Claims processor
CLM-409375 → UHC-49727-75 (Ralph Pierce)
Member id
UHC-49727-75
Confidence
1
Method
probabilistic
MBR-022975CLM-409375
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003824
Orphan claim re-pointed
Claims processor
CLM-404592 → UHC-08657-37 (Jason King)
Member id
UHC-08657-37
Confidence
1
Method
probabilistic
MBR-011674CLM-404592
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003825
Orphan claim re-pointed
Claims processor
CLM-407770 → UHC-00633-60 (Noah Miller)
Member id
UHC-00633-60
Confidence
1
Method
probabilistic
MBR-002977CLM-407770
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003826
Orphan claim re-pointed
Claims processor
CLM-431707 → UHC-56875-41 (Christine Wallace)
Member id
UHC-56875-41
Confidence
1
Method
probabilistic
MBR-000404CLM-431707
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003827
Orphan claim re-pointed
Claims processor
CLM-424985 → UHC-14487-06 (Grace Lane)
Member id
UHC-14487-06
Confidence
0.97
Method
deterministic
MBR-026918CLM-424985
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003828
Orphan claim re-pointed
Claims processor
CLM-411246 → UHC-41677-84 (Steven Phillips)
Member id
UHC-41677-84
Confidence
0.98
Method
probabilistic
MBR-012303CLM-411246
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003829
Orphan claim re-pointed
Claims processor
CLM-413976 → UHC-32060-55 (Christina Owens)
Member id
UHC-32060-55
Confidence
0.99
Method
probabilistic
MBR-011319CLM-413976
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003830
Orphan claim re-pointed
Claims processor
CLM-401597 → UHC-21240-90 (Brandon Porter)
Member id
UHC-21240-90
Confidence
0.91
Method
probabilistic
MBR-021518CLM-401597
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003831
Orphan claim re-pointed
Claims processor
CLM-403347 → UHC-72868-40 (Sofia Vargas)
Member id
UHC-72868-40
Confidence
1
Method
probabilistic
MBR-006981CLM-403347
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003832
Orphan claim re-pointed
Claims processor
CLM-412697 → UHC-82671-87 (Virginia Porter)
Member id
UHC-82671-87
Confidence
1
Method
probabilistic
MBR-009586CLM-412697
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003833
Orphan claim re-pointed
Claims processor
CLM-426898 → UHC-76883-32 (Ethan Rogers)
Member id
UHC-76883-32
Confidence
1
Method
probabilistic
MBR-004933CLM-426898
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003834
Orphan claim re-pointed
Claims processor
CLM-418170 → UHC-18712-38 (Gerald Henderson)
Member id
UHC-18712-38
Confidence
0.97
Method
deterministic
MBR-004528CLM-418170
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003835
Orphan claim re-pointed
Claims processor
CLM-409857 → UHC-76932-93 (Eric Fisher)
Member id
UHC-76932-93
Confidence
1
Method
probabilistic
MBR-005107CLM-409857
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003836
Orphan claim re-pointed
Claims processor
CLM-419907 → UHC-09379-62 (Lisa Dunn)
Member id
UHC-09379-62
Confidence
0.97
Method
deterministic
MBR-041809CLM-419907
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003837
Orphan claim re-pointed
Claims processor
CLM-410537 → UHC-61330-54 (Adam Bailey)
Member id
UHC-61330-54
Confidence
1
Method
probabilistic
MBR-008534CLM-410537
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003838
Orphan claim re-pointed
Claims processor
CLM-431536 → UHC-98440-07 (Amanda Li)
Member id
UHC-98440-07
Confidence
1
Method
probabilistic
MBR-033044CLM-431536
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003839
Orphan claim re-pointed
Claims processor
CLM-426279 → UHC-67538-62 (Donald Morales)
Member id
UHC-67538-62
Confidence
1
Method
probabilistic
MBR-014058CLM-426279
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003840
Orphan claim re-pointed
Claims processor
CLM-420039 → UHC-96523-84 (Kayla Cole)
Member id
UHC-96523-84
Confidence
1
Method
probabilistic
MBR-013700CLM-420039
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003841
Orphan claim re-pointed
Claims processor
CLM-414874 → UHC-06004-43 (Wei Romero)
Member id
UHC-06004-43
Confidence
1
Method
probabilistic
MBR-021169CLM-414874
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003842
Orphan claim re-pointed
Claims processor
CLM-424488 → UHC-59681-63 (Douglas Stephens)
Member id
UHC-59681-63
Confidence
1
Method
probabilistic
MBR-006488CLM-424488
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003843
Orphan claim re-pointed
Claims processor
CLM-426078 → UHC-23575-28 (Lauren Peters)
Member id
UHC-23575-28
Confidence
1
Method
probabilistic
MBR-009118CLM-426078
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003844
Orphan claim re-pointed
Claims processor
CLM-404108 → UHC-34223-83 (Carol Stevens)
Member id
UHC-34223-83
Confidence
0.98
Method
probabilistic
MBR-025490CLM-404108
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003845
Orphan claim re-pointed
Claims processor
CLM-426461 → UHC-23862-12 (Heather Long)
Member id
UHC-23862-12
Confidence
1.00
Method
probabilistic
MBR-009822CLM-426461
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003846
Orphan claim re-pointed
Claims processor
CLM-419795 → UHC-32104-52 (Patricia Fox)
Member id
UHC-32104-52
Confidence
0.97
Method
deterministic
MBR-025384CLM-419795
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003847
Orphan claim re-pointed
Claims processor
CLM-401521 → UHC-93729-34 (Gloria Perry)
Member id
UHC-93729-34
Confidence
0.99
Method
probabilistic
MBR-014602CLM-401521
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003848
Orphan claim re-pointed
Claims processor
CLM-403087 → UHC-95054-93 (Valentina Banks)
Member id
UHC-95054-93
Confidence
1
Method
probabilistic
MBR-005548CLM-403087
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003849
Orphan claim re-pointed
Claims processor
CLM-405085 → UHC-84948-25 (Judith Lopez)
Member id
UHC-84948-25
Confidence
1
Method
probabilistic
MBR-003221CLM-405085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003850
Orphan claim re-pointed
Claims processor
CLM-407300 → UHC-08247-33 (Rachel Crawford)
Member id
UHC-08247-33
Confidence
1
Method
probabilistic
MBR-013249CLM-407300
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003851
Orphan claim re-pointed
Claims processor
CLM-414193 → UHC-19695-21 (Henry Holmes)
Member id
UHC-19695-21
Confidence
1
Method
probabilistic
MBR-039441CLM-414193
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003852
Orphan claim re-pointed
Claims processor
CLM-403983 → UHC-17641-18 (Sandra Price)
Member id
UHC-17641-18
Confidence
1
Method
probabilistic
MBR-001514CLM-403983
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003853
Orphan claim re-pointed
Claims processor
CLM-410112 → UHC-15032-29 (Jose Watkins)
Member id
UHC-15032-29
Confidence
1
Method
probabilistic
MBR-015663CLM-410112
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003854
Orphan claim re-pointed
Claims processor
CLM-431045 → UHC-86497-82 (Christine Sullivan)
Member id
UHC-86497-82
Confidence
1
Method
probabilistic
MBR-014703CLM-431045
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003855
Orphan claim re-pointed
Claims processor
CLM-400430 → UHC-60033-71 (Bradley Carroll)
Member id
UHC-60033-71
Confidence
1
Method
probabilistic
MBR-016939CLM-400430
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003856
Orphan claim re-pointed
Claims processor
CLM-427644 → UHC-03883-52 (Luis Wang)
Member id
UHC-03883-52
Confidence
1
Method
probabilistic
MBR-019438CLM-427644
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003857
Orphan claim re-pointed
Claims processor
CLM-404842 → UHC-27496-70 (Yuki Nguyen)
Member id
UHC-27496-70
Confidence
1
Method
probabilistic
MBR-021547CLM-404842
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003858
Orphan claim re-pointed
Claims processor
CLM-410538 → UHC-61330-54 (Adam Bailey)
Member id
UHC-61330-54
Confidence
1
Method
probabilistic
MBR-008534CLM-410538
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003859
Orphan claim re-pointed
Claims processor
CLM-403857 → UHC-86487-52 (Mei Rogers)
Member id
UHC-86487-52
Confidence
0.93
Method
probabilistic
MBR-019218CLM-403857
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003860
Orphan claim re-pointed
Claims processor
CLM-401208 → UHC-00824-54 (Ana Knight)
Member id
UHC-00824-54
Confidence
0.99
Method
probabilistic
MBR-003187CLM-401208
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003861
Orphan claim re-pointed
Claims processor
CLM-428261 → UHC-39713-31 (Bryan Perry)
Member id
UHC-39713-31
Confidence
0.98
Method
probabilistic
MBR-016229CLM-428261
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 215 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.