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-005912 | Orphan claim re-pointed Claims processor | CLM-429090 → UHC-51214-95 (Peter Carlson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005913 | Orphan claim re-pointed Claims processor | CLM-422323 → UHC-48098-19 (Heather Cox) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005914 | Orphan claim re-pointed Claims processor | CLM-416663 → UHC-14238-55 (Janice Estrada) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005915 | Orphan claim re-pointed Claims processor | CLM-404545 → UHC-68477-97 (Katherine Wang) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005916 | Orphan claim re-pointed Claims processor | CLM-407369 → UHC-17804-04 (Charlotte Saanchez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005917 | Orphan claim re-pointed Claims processor | CLM-417202 → UHC-33529-32 (Marilyn Ferguson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005918 | Orphan claim re-pointed Claims processor | CLM-426368 → UHC-84044-69 (Christian Wlison) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005919 | Orphan claim re-pointed Claims processor | CLM-408108 → UHC-43255-16 (Ralph Lewis) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005920 | Orphan claim re-pointed Claims processor | CLM-417149 → UHC-09268-60 (Maria Hansen) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005921 | Orphan claim re-pointed Claims processor | CLM-417426 → UHC-46623-02 (Donna Evans) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005922 | Orphan claim re-pointed Claims processor | CLM-416458 → UHC-52938-21 (Kenneth Miller) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005923 | Orphan claim re-pointed Claims processor | CLM-400188 → UHC-68096-32 (Danielle Gordon) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005924 | Orphan claim re-pointed Claims processor | CLM-416394 → UHC-27931-26 (Vincent Ruiz) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005925 | Orphan claim re-pointed Claims processor | CLM-409758 → UHC-39860-37 (Bryan Martinez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005926 | Orphan claim re-pointed Claims processor | CLM-429907 → UHC-21868-51 (John Carlson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005927 | Orphan claim re-pointed Claims processor | CLM-427997 → UHC-01048-26 (Raymond Reed) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005928 | Orphan claim re-pointed Claims processor | CLM-420519 → UHC-56404-63 (Omar Myers) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005929 | Orphan claim re-pointed Claims processor | CLM-411249 → UHC-83791-96 (Julie Wright) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005930 | Orphan claim re-pointed Claims processor | CLM-413210 → UHC-90583-29 (Kathryn Bradley) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005931 | Orphan claim re-pointed Claims processor | CLM-430882 → UHC-00961-08 (Austin Espinoza) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005932 | Orphan claim re-pointed Claims processor | CLM-424377 → UHC-60990-54 (Anna Morris) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005933 | Orphan claim re-pointed Claims processor | CLM-426242 → UHC-67975-18 (Hannah Munoz) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005934 | Orphan claim re-pointed Claims processor | CLM-403814 → UHC-20741-25 (Jesse Alvarez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005935 | Orphan claim re-pointed Claims processor | CLM-416019 → UHC-49073-83 (Fatima Butler) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005936 | Orphan claim re-pointed Claims processor | CLM-416233 → UHC-74762-12 (Andrew Dominguez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005937 | Orphan claim re-pointed Claims processor | CLM-431555 → UHC-06184-67 (Yuki Simpson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005938 | Orphan claim re-pointed Claims processor | CLM-417912 → UHC-05769-17 (Carlos Gordon) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005939 | Orphan claim re-pointed Claims processor | CLM-413795 → UHC-19461-15 (Denise Ortega) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005940 | Orphan claim re-pointed Claims processor | CLM-426563 → UHC-72208-98 (Sara Franklin) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005941 | Orphan claim re-pointed Claims processor | CLM-432228 → UHC-45743-43 (Wayne Contreras) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005942 | Orphan claim re-pointed Claims processor | CLM-400215 → UHC-17817-28 (Harold Pena) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005943 | Orphan claim re-pointed Claims processor | CLM-400891 → UHC-49242-29 (Ashley Thomas) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005944 | Orphan claim re-pointed Claims processor | CLM-422556 → UHC-66516-34 (Benjamin Payne) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005945 | Orphan claim re-pointed Claims processor | CLM-400370 → UHC-52024-75 (Grace Burton) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005946 | Orphan claim re-pointed Claims processor | CLM-424413 → UHC-51204-16 (Jerry Edwards) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005947 | Orphan claim re-pointed Claims processor | CLM-408256 → UHC-95675-57 (Kayla Chen) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005948 | Orphan claim re-pointed Claims processor | CLM-422798 → UHC-87251-20 (Shirley Hunter) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005949 | Orphan claim re-pointed Claims processor | CLM-415000 → UHC-74723-28 (Roy Reid) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005950 | Orphan claim re-pointed Claims processor | CLM-410780 → UHC-75557-23 (Judy Martin) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005951 | Orphan claim re-pointed Claims processor | CLM-418250 → UHC-45600-90 (Sharon Mendoza) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005952 | Orphan claim re-pointed Claims processor | CLM-428206 → UHC-69971-22 (Russell Fowler) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005953 | Orphan claim re-pointed Claims processor | CLM-432114 → UHC-50358-46 (Julie Miller) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005954 | Orphan claim re-pointed Claims processor | CLM-421528 → UHC-96605-12 (Omar Webb) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005955 | Orphan claim re-pointed Claims processor | CLM-408645 → UHC-16249-96 (Nicholas Lane) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005956 | Orphan claim re-pointed Claims processor | CLM-411620 → UHC-99981-18 (Olivia Espinoza) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005957 | Orphan claim re-pointed Claims processor | CLM-431780 → UHC-07698-10 (Ashley Singh) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005958 | Orphan claim re-pointed Claims processor | CLM-417837 → UHC-82219-84 (Michael Lynch) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005959 | Orphan claim re-pointed Claims processor | CLM-406495 → UHC-54871-91 (Omar Torres) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005960 | Orphan claim re-pointed Claims processor | CLM-424074 → UHC-66712-26 (Lawrence Hayes) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-005961 | Orphan claim re-pointed Claims processor | CLM-402706 → UHC-79002-63 (Russell Berry) |
| 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.