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-004362
Orphan claim re-pointed
Claims processor
CLM-420615 → UHC-70265-57 (Sandra Bell)
Member id
UHC-70265-57
Confidence
0.97
Method
deterministic
MBR-015249CLM-420615
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004363
Orphan claim re-pointed
Claims processor
CLM-410809 → UHC-06257-82 (Nicole Richardson)
Member id
UHC-06257-82
Confidence
1
Method
probabilistic
MBR-001810CLM-410809
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004364
Orphan claim re-pointed
Claims processor
CLM-405577 → UHC-79801-51 (Aaron Cruz)
Member id
UHC-79801-51
Confidence
1
Method
probabilistic
MBR-001084CLM-405577
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004365
Orphan claim re-pointed
Claims processor
CLM-420795 → UHC-91720-52 (Aaron Pierce)
Member id
UHC-91720-52
Confidence
1
Method
probabilistic
MBR-006931CLM-420795
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004366
Orphan claim re-pointed
Claims processor
CLM-402438 → UHC-00799-30 (Billy Armstrong)
Member id
UHC-00799-30
Confidence
1
Method
probabilistic
MBR-008972CLM-402438
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004367
Orphan claim re-pointed
Claims processor
CLM-405462 → UHC-90340-61 (Jessica Alexander)
Member id
UHC-90340-61
Confidence
1.00
Method
probabilistic
MBR-009061CLM-405462
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004368
Orphan claim re-pointed
Claims processor
CLM-432468 → UHC-22050-94 (Donald Simpson)
Member id
UHC-22050-94
Confidence
1
Method
probabilistic
MBR-008385CLM-432468
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004369
Orphan claim re-pointed
Claims processor
CLM-425783 → UHC-18122-45 (Philip Graham)
Member id
UHC-18122-45
Confidence
1
Method
probabilistic
MBR-014474CLM-425783
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004370
Orphan claim re-pointed
Claims processor
CLM-405684 → UHC-36039-09 (Nancy Soto)
Member id
UHC-36039-09
Confidence
1
Method
probabilistic
MBR-010941CLM-405684
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004371
Orphan claim re-pointed
Claims processor
CLM-412080 → UHC-44248-84 (Greg Moreno)
Member id
UHC-44248-84
Confidence
1
Method
probabilistic
MBR-037864CLM-412080
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004372
Orphan claim re-pointed
Claims processor
CLM-402392 → UHC-86655-79 (Carl Morales)
Member id
UHC-86655-79
Confidence
0.99
Method
probabilistic
MBR-017157CLM-402392
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004373
Orphan claim re-pointed
Claims processor
CLM-418352 → UHC-74847-84 (Bobby Wright)
Member id
UHC-74847-84
Confidence
1
Method
probabilistic
MBR-005523CLM-418352
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004374
Orphan claim re-pointed
Claims processor
CLM-404881 → UHC-28782-70 (Kayla Williamson)
Member id
UHC-28782-70
Confidence
1
Method
probabilistic
MBR-005574CLM-404881
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004375
Orphan claim re-pointed
Claims processor
CLM-400997 → UHC-22655-79 (Diane Washington)
Member id
UHC-22655-79
Confidence
0.99
Method
probabilistic
MBR-003213CLM-400997
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004376
Orphan claim re-pointed
Claims processor
CLM-429215 → UHC-51289-46 (Christine Vega)
Member id
UHC-51289-46
Confidence
1
Method
probabilistic
MBR-007977CLM-429215
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004377
Orphan claim re-pointed
Claims processor
CLM-404216 → UHC-78034-52 (Phiilp Bell)
Member id
UHC-78034-52
Confidence
0.99
Method
probabilistic
MBR-001974CLM-404216
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004378
Orphan claim re-pointed
Claims processor
CLM-403531 → UHC-00007-16 (Megan Davis)
Member id
UHC-00007-16
Confidence
1
Method
probabilistic
MBR-007683CLM-403531
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004379
Orphan claim re-pointed
Claims processor
CLM-407904 → UHC-80744-56 (Tyler Oliver)
Member id
UHC-80744-56
Confidence
1
Method
probabilistic
MBR-010291CLM-407904
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004380
Orphan claim re-pointed
Claims processor
CLM-423645 → UHC-08974-21 (Daniel Lawrence)
Member id
UHC-08974-21
Confidence
0.97
Method
deterministic
MBR-028194CLM-423645
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004381
Orphan claim re-pointed
Claims processor
CLM-420928 → UHC-14343-17 (Theresa Parker)
Member id
UHC-14343-17
Confidence
1
Method
probabilistic
MBR-011124CLM-420928
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004382
Orphan claim re-pointed
Claims processor
CLM-420058 → UHC-22457-29 (Christina Hunter)
Member id
UHC-22457-29
Confidence
1
Method
probabilistic
MBR-025701CLM-420058
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004383
Orphan claim re-pointed
Claims processor
CLM-403515 → UHC-67445-33 (Carlos Perkins)
Member id
UHC-67445-33
Confidence
0.99
Method
probabilistic
MBR-041211CLM-403515
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004384
Orphan claim re-pointed
Claims processor
CLM-404579 → UHC-86611-68 (Amber White)
Member id
UHC-86611-68
Confidence
1
Method
probabilistic
MBR-000307CLM-404579
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004385
Orphan claim re-pointed
Claims processor
CLM-418887 → UHC-49421-70 (Willie Ray)
Member id
UHC-49421-70
Confidence
1
Method
probabilistic
MBR-004824CLM-418887
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004386
Orphan claim re-pointed
Claims processor
CLM-414517 → UHC-95289-30 (Kimberly Cooper)
Member id
UHC-95289-30
Confidence
1
Method
probabilistic
MBR-021961CLM-414517
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004387
Orphan claim re-pointed
Claims processor
CLM-412270 → UHC-62023-76 (David Hansen)
Member id
UHC-62023-76
Confidence
1
Method
probabilistic
MBR-022426CLM-412270
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004388
Orphan claim re-pointed
Claims processor
CLM-401836 → UHC-69471-08 (Cynthia Ray)
Member id
UHC-69471-08
Confidence
1
Method
probabilistic
MBR-016886CLM-401836
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004389
Orphan claim re-pointed
Claims processor
CLM-408033 → UHC-18542-99 (Deborah Freeman)
Member id
UHC-18542-99
Confidence
1.00
Method
probabilistic
MBR-029997CLM-408033
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004390
Orphan claim re-pointed
Claims processor
CLM-423417 → UHC-62843-17 (Emily Snyder)
Member id
UHC-62843-17
Confidence
1
Method
probabilistic
MBR-014892CLM-423417
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004391
Orphan claim re-pointed
Claims processor
CLM-429691 → UHC-70178-05 (Ashley Ryan)
Member id
UHC-70178-05
Confidence
1
Method
probabilistic
MBR-023836CLM-429691
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004392
Orphan claim re-pointed
Claims processor
CLM-422364 → UHC-30222-93 (Ann Young)
Member id
UHC-30222-93
Confidence
1
Method
probabilistic
MBR-027407CLM-422364
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004393
Orphan claim re-pointed
Claims processor
CLM-424933 → UHC-94406-85 (Tyler Wells)
Member id
UHC-94406-85
Confidence
1
Method
probabilistic
MBR-000041CLM-424933
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004394
Orphan claim re-pointed
Claims processor
CLM-411876 → UHC-36360-26 (Theresa Cruz)
Member id
UHC-36360-26
Confidence
1
Method
probabilistic
MBR-007332CLM-411876
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004395
Orphan claim re-pointed
Claims processor
CLM-430481 → UHC-37303-83 (Alan Lopez)
Member id
UHC-37303-83
Confidence
1
Method
probabilistic
MBR-026491CLM-430481
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004396
Orphan claim re-pointed
Claims processor
CLM-402538 → UHC-62141-75 (Billy Green)
Member id
UHC-62141-75
Confidence
0.97
Method
deterministic
MBR-006938CLM-402538
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004397
Orphan claim re-pointed
Claims processor
CLM-407586 → UHC-91617-74 (Albert Murray)
Member id
UHC-91617-74
Confidence
1
Method
probabilistic
MBR-002154CLM-407586
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004398
Orphan claim re-pointed
Claims processor
CLM-426540 → UHC-03403-79 (Douglas Harris)
Member id
UHC-03403-79
Confidence
1
Method
probabilistic
MBR-026377CLM-426540
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004399
Orphan claim re-pointed
Claims processor
CLM-422603 → UHC-61347-18 (Thomas Day)
Member id
UHC-61347-18
Confidence
1
Method
probabilistic
MBR-003990CLM-422603
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004400
Orphan claim re-pointed
Claims processor
CLM-409086 → UHC-61419-84 (Kathryn Knight)
Member id
UHC-61419-84
Confidence
1
Method
probabilistic
MBR-013145CLM-409086
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004401
Orphan claim re-pointed
Claims processor
CLM-413409 → UHC-38793-60 (Bradley Martinez)
Member id
UHC-38793-60
Confidence
0.97
Method
deterministic
MBR-019398CLM-413409
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004402
Orphan claim re-pointed
Claims processor
CLM-419055 → UHC-96097-03 (Randy Flores)
Member id
UHC-96097-03
Confidence
1
Method
probabilistic
MBR-005234CLM-419055
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004403
Orphan claim re-pointed
Claims processor
CLM-426197 → UHC-50611-25 (Kathleen Boyd)
Member id
UHC-50611-25
Confidence
0.94
Method
probabilistic
MBR-032245CLM-426197
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004404
Orphan claim re-pointed
Claims processor
CLM-428927 → UHC-86763-22 (Kimberly Bell)
Member id
UHC-86763-22
Confidence
0.97
Method
deterministic
MBR-018763CLM-428927
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004405
Orphan claim re-pointed
Claims processor
CLM-411740 → UHC-26060-45 (Priya Tucker)
Member id
UHC-26060-45
Confidence
0.97
Method
deterministic
MBR-001814CLM-411740
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004406
Orphan claim re-pointed
Claims processor
CLM-421491 → UHC-33392-38 (Eugene Diaz)
Member id
UHC-33392-38
Confidence
1
Method
probabilistic
MBR-000996CLM-421491
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004407
Orphan claim re-pointed
Claims processor
CLM-428280 → UHC-51886-82 (Emily Montgomery)
Member id
UHC-51886-82
Confidence
0.97
Method
deterministic
MBR-011148CLM-428280
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004408
Orphan claim re-pointed
Claims processor
CLM-416999 → UHC-38087-84 (Daniel Jimenez)
Member id
UHC-38087-84
Confidence
1
Method
probabilistic
MBR-007268CLM-416999
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004409
Orphan claim re-pointed
Claims processor
CLM-430694 → UHC-42126-16 (Lucia Gomez)
Member id
UHC-42126-16
Confidence
1
Method
probabilistic
MBR-003739CLM-430694
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004410
Orphan claim re-pointed
Claims processor
CLM-405853 → UHC-52255-77 (Kelly Aguilar)
Member id
UHC-52255-77
Confidence
1
Method
probabilistic
MBR-007244CLM-405853
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004411
Orphan claim re-pointed
Claims processor
CLM-418738 → UHC-20447-25 (Willie Walsh)
Member id
UHC-20447-25
Confidence
0.97
Method
deterministic
MBR-017635CLM-418738
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 226 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.