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-004762
Orphan claim re-pointed
Claims processor
CLM-429854 → UHC-22640-29 (Amanda Phillips)
Member id
UHC-22640-29
Confidence
1
Method
probabilistic
MBR-006865CLM-429854
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004763
Orphan claim re-pointed
Claims processor
CLM-409576 → UHC-33964-15 (Heather Welch)
Member id
UHC-33964-15
Confidence
1
Method
probabilistic
MBR-037423CLM-409576
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004764
Orphan claim re-pointed
Claims processor
CLM-414633 → UHC-11790-26 (Kelly Kim)
Member id
UHC-11790-26
Confidence
1
Method
probabilistic
MBR-044573CLM-414633
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004765
Orphan claim re-pointed
Claims processor
CLM-405895 → UHC-78188-24 (Debra Greene)
Member id
UHC-78188-24
Confidence
1
Method
probabilistic
MBR-006222CLM-405895
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004766
Orphan claim re-pointed
Claims processor
CLM-419277 → UHC-11444-52 (Diane Yang)
Member id
UHC-11444-52
Confidence
0.99
Method
probabilistic
MBR-018855CLM-419277
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004767
Orphan claim re-pointed
Claims processor
CLM-429968 → UHC-84734-28 (Arjun Jackkson)
Member id
UHC-84734-28
Confidence
0.99
Method
probabilistic
MBR-015094CLM-429968
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004768
Orphan claim re-pointed
Claims processor
CLM-402518 → UHC-68529-89 (Ethan Estrada)
Member id
UHC-68529-89
Confidence
1
Method
probabilistic
MBR-007062CLM-402518
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004769
Orphan claim re-pointed
Claims processor
CLM-407468 → UHC-02582-56 (Christian Reynolds)
Member id
UHC-02582-56
Confidence
0.99
Method
probabilistic
MBR-005059CLM-407468
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004770
Orphan claim re-pointed
Claims processor
CLM-427088 → UHC-39366-98 (James Banks)
Member id
UHC-39366-98
Confidence
1
Method
probabilistic
MBR-008230CLM-427088
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004771
Orphan claim re-pointed
Claims processor
CLM-419421 → UHC-45305-19 (Sharon Sanchez)
Member id
UHC-45305-19
Confidence
1
Method
probabilistic
MBR-021047CLM-419421
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004772
Orphan claim re-pointed
Claims processor
CLM-410369 → UHC-25525-72 (Aaron Larson)
Member id
UHC-25525-72
Confidence
0.99
Method
probabilistic
MBR-014413CLM-410369
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004773
Orphan claim re-pointed
Claims processor
CLM-415227 → UHC-63802-23 (Robert Knight)
Member id
UHC-63802-23
Confidence
1
Method
probabilistic
MBR-010907CLM-415227
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004774
Orphan claim re-pointed
Claims processor
CLM-408887 → UHC-13959-33 (Lawrence Wrihgt)
Member id
UHC-13959-33
Confidence
0.99
Method
probabilistic
MBR-008342CLM-408887
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004775
Orphan claim re-pointed
Claims processor
CLM-426201 → UHC-47553-11 (Roy Wilson)
Member id
UHC-47553-11
Confidence
0.99
Method
probabilistic
MBR-013681CLM-426201
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004776
Orphan claim re-pointed
Claims processor
CLM-418676 → UHC-77633-66 (Tyler Parker)
Member id
UHC-77633-66
Confidence
1
Method
probabilistic
MBR-000738CLM-418676
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004777
Orphan claim re-pointed
Claims processor
CLM-425957 → UHC-38146-61 (Kevin Ortega)
Member id
UHC-38146-61
Confidence
1
Method
probabilistic
MBR-008767CLM-425957
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004778
Orphan claim re-pointed
Claims processor
CLM-409494 → UHC-14810-76 (Nathan Cunningham)
Member id
UHC-14810-76
Confidence
1
Method
probabilistic
MBR-000595CLM-409494
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004779
Orphan claim re-pointed
Claims processor
CLM-415253 → UHC-16904-99 (Ralph Pena)
Member id
UHC-16904-99
Confidence
1
Method
probabilistic
MBR-031031CLM-415253
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004780
Orphan claim re-pointed
Claims processor
CLM-432716 → UHC-06936-55 (Randy Riley)
Member id
UHC-06936-55
Confidence
1
Method
probabilistic
MBR-032268CLM-432716
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004781
Orphan claim re-pointed
Claims processor
CLM-420357 → UHC-14793-72 (Douglas Allen)
Member id
UHC-14793-72
Confidence
0.87
Method
probabilistic
MBR-011014CLM-420357
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004782
Orphan claim re-pointed
Claims processor
CLM-431553 → UHC-73170-37 (Rebecca Payne)
Member id
UHC-73170-37
Confidence
1
Method
probabilistic
MBR-027275CLM-431553
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004783
Orphan claim re-pointed
Claims processor
CLM-430804 → UHC-14233-10 (Kyle Hunt)
Member id
UHC-14233-10
Confidence
0.99
Method
probabilistic
MBR-014948CLM-430804
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004784
Orphan claim re-pointed
Claims processor
CLM-406966 → UHC-40110-94 (Laura Burke)
Member id
UHC-40110-94
Confidence
1
Method
probabilistic
MBR-015440CLM-406966
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004785
Orphan claim re-pointed
Claims processor
CLM-411725 → UHC-06365-30 (Melissa Jordan)
Member id
UHC-06365-30
Confidence
1
Method
probabilistic
MBR-032427CLM-411725
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004786
Orphan claim re-pointed
Claims processor
CLM-428540 → UHC-66312-14 (Megan Carter)
Member id
UHC-66312-14
Confidence
1
Method
probabilistic
MBR-023199CLM-428540
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004787
Orphan claim re-pointed
Claims processor
CLM-419487 → UHC-42918-02 (Judith Knight)
Member id
UHC-42918-02
Confidence
1
Method
probabilistic
MBR-021292CLM-419487
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004788
Orphan claim re-pointed
Claims processor
CLM-428360 → UHC-69403-78 (Willie Chen)
Member id
UHC-69403-78
Confidence
1
Method
probabilistic
MBR-016007CLM-428360
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004789
Orphan claim re-pointed
Claims processor
CLM-426793 → UHC-66958-89 (Kenneth Washington)
Member id
UHC-66958-89
Confidence
1
Method
probabilistic
MBR-011601CLM-426793
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004790
Orphan claim re-pointed
Claims processor
CLM-430730 → UHC-27796-57 (Austin Santos)
Member id
UHC-27796-57
Confidence
1
Method
probabilistic
MBR-001096CLM-430730
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004791
Orphan claim re-pointed
Claims processor
CLM-408239 → UHC-78834-80 (Carolyn Sandoval)
Member id
UHC-78834-80
Confidence
1
Method
probabilistic
MBR-024236CLM-408239
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004792
Orphan claim re-pointed
Claims processor
CLM-402269 → UHC-83618-98 (Camila Martinez)
Member id
UHC-83618-98
Confidence
1
Method
probabilistic
MBR-032157CLM-402269
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004793
Orphan claim re-pointed
Claims processor
CLM-402062 → UHC-84370-28 (Barbara Jacobs)
Member id
UHC-84370-28
Confidence
1
Method
probabilistic
MBR-002484CLM-402062
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004794
Orphan claim re-pointed
Claims processor
CLM-429588 → UHC-00755-30 (Joan Mason)
Member id
UHC-00755-30
Confidence
1
Method
probabilistic
MBR-019530CLM-429588
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004795
Orphan claim re-pointed
Claims processor
CLM-429450 → UHC-73700-75 (Christina Garcia)
Member id
UHC-73700-75
Confidence
1.00
Method
probabilistic
MBR-025498CLM-429450
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004796
Orphan claim re-pointed
Claims processor
CLM-412213 → UHC-14032-93 (Dennis Perez)
Member id
UHC-14032-93
Confidence
1
Method
probabilistic
MBR-022525CLM-412213
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004797
Orphan claim re-pointed
Claims processor
CLM-419400 → UHC-74941-59 (Tyler Peters)
Member id
UHC-74941-59
Confidence
1
Method
probabilistic
MBR-002527CLM-419400
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004798
Orphan claim re-pointed
Claims processor
CLM-413939 → UHC-01330-32 (Albert Marshall)
Member id
UHC-01330-32
Confidence
1
Method
probabilistic
MBR-023427CLM-413939
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004799
Orphan claim re-pointed
Claims processor
CLM-418517 → UHC-37938-14 (Virginia Hudson)
Member id
UHC-37938-14
Confidence
1
Method
probabilistic
MBR-017471CLM-418517
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004800
Orphan claim re-pointed
Claims processor
CLM-429781 → UHC-42785-62 (Frances Lawson)
Member id
UHC-42785-62
Confidence
0.94
Method
probabilistic
MBR-007191CLM-429781
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004801
Orphan claim re-pointed
Claims processor
CLM-414188 → UHC-43975-35 (Dennis Castillo)
Member id
UHC-43975-35
Confidence
0.97
Method
deterministic
MBR-003705CLM-414188
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004802
Orphan claim re-pointed
Claims processor
CLM-413718 → UHC-77881-56 (Jacqueline Wagner)
Member id
UHC-77881-56
Confidence
1
Method
probabilistic
MBR-013134CLM-413718
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004803
Orphan claim re-pointed
Claims processor
CLM-407437 → UHC-88794-67 (Christopher Adams)
Member id
UHC-88794-67
Confidence
1
Method
probabilistic
MBR-026656CLM-407437
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004804
Orphan claim re-pointed
Claims processor
CLM-421509 → UHC-40709-05 (Angla Burns)
Member id
UHC-40709-05
Confidence
1
Method
probabilistic
MBR-005336CLM-421509
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004805
Orphan claim re-pointed
Claims processor
CLM-416820 → UHC-87642-81 (Diana Chen)
Member id
UHC-87642-81
Confidence
1
Method
probabilistic
MBR-001286CLM-416820
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004806
Orphan claim re-pointed
Claims processor
CLM-403610 → UHC-77954-08 (Robert Jordan)
Member id
UHC-77954-08
Confidence
0.93
Method
probabilistic
MBR-008675CLM-403610
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004807
Orphan claim re-pointed
Claims processor
CLM-406802 → UHC-22406-82 (Jacob King)
Member id
UHC-22406-82
Confidence
0.99
Method
probabilistic
MBR-001075CLM-406802
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004808
Orphan claim re-pointed
Claims processor
CLM-430490 → UHC-60974-69 (Lucia Welch)
Member id
UHC-60974-69
Confidence
1
Method
probabilistic
MBR-022786CLM-430490
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004809
Orphan claim re-pointed
Claims processor
CLM-431715 → UHC-55885-02 (Carol Lane)
Member id
UHC-55885-02
Confidence
1
Method
probabilistic
MBR-005029CLM-431715
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004810
Orphan claim re-pointed
Claims processor
CLM-427438 → UHC-79164-92 (Julie Garrett)
Member id
UHC-79164-92
Confidence
1
Method
probabilistic
MBR-022053CLM-427438
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004811
Orphan claim re-pointed
Claims processor
CLM-411538 → UHC-33371-57 (Linda Burns)
Member id
UHC-33371-57
Confidence
0.97
Method
deterministic
MBR-031869CLM-411538
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 234 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.