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-006012 | Orphan claim re-pointed Claims processor | CLM-430819 → UHC-68161-24 (Timothy Edwards) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006013 | Orphan claim re-pointed Claims processor | CLM-406068 → UHC-46484-67 (Julie Vasquez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006014 | Orphan claim re-pointed Claims processor | CLM-407213 → UHC-59562-45 (Kimberly Munoz) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006015 | Orphan claim re-pointed Claims processor | CLM-408778 → UHC-05379-68 (Karen Jackson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006016 | Orphan claim re-pointed Claims processor | CLM-401023 → UHC-64353-07 (Russell Burton) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006017 | Orphan claim re-pointed Claims processor | CLM-412198 → UHC-77913-35 (Mark Tran) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006018 | Orphan claim re-pointed Claims processor | CLM-423901 → UHC-59443-95 (Sue Medina) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006019 | Orphan claim re-pointed Claims processor | CLM-405921 → UHC-06063-03 (Steven Ortega) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006020 | Orphan claim re-pointed Claims processor | CLM-409899 → UHC-09453-25 (Martha Gonzales) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006021 | Orphan claim re-pointed Claims processor | CLM-423180 → UHC-16103-42 (Karen Campbell) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006022 | Orphan claim re-pointed Claims processor | CLM-424978 → UHC-49053-18 (Denise Anderson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006023 | Orphan claim re-pointed Claims processor | CLM-418191 → UHC-69143-25 (Jacqueline Andrews) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006024 | Orphan claim re-pointed Claims processor | CLM-420544 → UHC-67709-81 (Omar Lopez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006025 | Orphan claim re-pointed Claims processor | CLM-413914 → UHC-21572-47 (Arthur Marshall) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006026 | Orphan claim re-pointed Claims processor | CLM-430575 → UHC-01568-37 (Arthur Robertson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006027 | Orphan claim re-pointed Claims processor | CLM-423241 → UHC-07284-72 (Lisa Anderson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006028 | Orphan claim re-pointed Claims processor | CLM-407064 → UHC-79424-39 (Stephanie Hart) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006029 | Orphan claim re-pointed Claims processor | CLM-404806 → UHC-58390-27 (Laura Washington) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006030 | Orphan claim re-pointed Claims processor | CLM-431854 → UHC-47672-96 (Mateo Ortiz) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006031 | Orphan claim re-pointed Claims processor | CLM-413590 → UHC-59600-25 (Ahmed Hayes) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006032 | Orphan claim re-pointed Claims processor | CLM-429140 → UHC-12791-74 (Carl Gibson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006033 | Orphan claim re-pointed Claims processor | CLM-418085 → UHC-00748-41 (Lucia Montgomery) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006034 | Orphan claim re-pointed Claims processor | CLM-427655 → UHC-73287-27 (Kimberly Medina) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006035 | Orphan claim re-pointed Claims processor | CLM-410081 → UHC-90832-95 (Bobby Walsh) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006036 | Orphan claim re-pointed Claims processor | CLM-407938 → UHC-50774-33 (Willie Robertson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006037 | Orphan claim re-pointed Claims processor | CLM-411662 → UHC-39381-75 (Alexander Cruz) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006038 | Orphan claim re-pointed Claims processor | CLM-408485 → UHC-71172-51 (Ralph Johnston) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006039 | Orphan claim re-pointed Claims processor | CLM-405019 → UHC-26434-29 (Abigail George) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006040 | Orphan claim re-pointed Claims processor | CLM-403799 → UHC-29346-52 (Jeffrey Allen) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006041 | Orphan claim re-pointed Claims processor | CLM-404565 → UHC-07836-36 (Michael Henry) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006042 | Orphan claim re-pointed Claims processor | CLM-400978 → UHC-70835-52 (Camila Rogers) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006043 | Orphan claim re-pointed Claims processor | CLM-407168 → UHC-13526-42 (Michelle Burke) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006044 | Orphan claim re-pointed Claims processor | CLM-406933 → UHC-52060-85 (Amber Delgado) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006045 | Orphan claim re-pointed Claims processor | CLM-429939 → UHC-39409-51 (Lauren Johnson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006046 | Orphan claim re-pointed Claims processor | CLM-409231 → UHC-74736-34 (Olivia Ramos) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006047 | Orphan claim re-pointed Claims processor | CLM-430561 → UHC-53849-60 (Stephanie Cox) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006048 | Orphan claim re-pointed Claims processor | CLM-413360 → UHC-04677-70 (Ronald Padilla) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006049 | Orphan claim re-pointed Claims processor | CLM-427922 → UHC-68920-96 (Walter Duncan) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006050 | Orphan claim re-pointed Claims processor | CLM-404883 → UHC-49233-42 (Chapman Michael) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006051 | Orphan claim re-pointed Claims processor | CLM-429650 → UHC-48764-80 (Zachary Ellis) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006052 | Orphan claim re-pointed Claims processor | CLM-422786 → UHC-14805-65 (Eric Hunt) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006053 | Orphan claim re-pointed Claims processor | CLM-426511 → UHC-12094-45 (Bryan Pena) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006054 | Orphan claim re-pointed Claims processor | CLM-424579 → UHC-37864-18 (Austin Bell) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006055 | Orphan claim re-pointed Claims processor | CLM-432156 → UHC-76846-41 (Kelly Gutierrez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006056 | Orphan claim re-pointed Claims processor | CLM-413462 → UHC-68471-33 (Matthew Fowler) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006057 | Orphan claim re-pointed Claims processor | CLM-411408 → UHC-50056-60 (Nancy Castillo) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006058 | Orphan claim re-pointed Claims processor | CLM-418235 → UHC-90795-24 (Debra Hill) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006059 | Orphan claim re-pointed Claims processor | CLM-415597 → UHC-41853-46 (Ruth Hall) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006060 | Orphan claim re-pointed Claims processor | CLM-409561 → UHC-75955-49 (Elizabeth Olson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006061 | Orphan claim re-pointed Claims processor | CLM-428057 → UHC-10194-82 (Steven Matthews) |
| 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.