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-002590
Orphan claim re-pointed
Claims processor
CLM-414228 → UHC-88973-05 (Jesse Reyes)
Member id
UHC-88973-05
Confidence
0.94
Method
probabilistic
MBR-009347CLM-414228
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002591
Orphan claim re-pointed
Claims processor
CLM-404597 → UHC-74176-39 (Gay Hansen)
Member id
UHC-74176-39
Confidence
0.97
Method
deterministic
MBR-022718CLM-404597
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002592
Orphan claim re-pointed
Claims processor
CLM-428924 → UHC-50088-36 (Frank Woods)
Member id
UHC-50088-36
Confidence
0.97
Method
deterministic
MBR-043538CLM-428924
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002593
Orphan claim re-pointed
Claims processor
CLM-430043 → UHC-98864-36 (Mei Walsh)
Member id
UHC-98864-36
Confidence
1
Method
probabilistic
MBR-018523CLM-430043
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002594
Orphan claim re-pointed
Claims processor
CLM-401058 → UHC-17944-90 (Charles Hunter)
Member id
UHC-17944-90
Confidence
1
Method
probabilistic
MBR-009945CLM-401058
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002595
Orphan claim re-pointed
Claims processor
CLM-417727 → UHC-36471-89 (Logan Yang)
Member id
UHC-36471-89
Confidence
1
Method
probabilistic
MBR-001834CLM-417727
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002596
Orphan claim re-pointed
Claims processor
CLM-431950 → UHC-02686-18 (Michael Kim)
Member id
UHC-02686-18
Confidence
1
Method
probabilistic
MBR-014632CLM-431950
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002597
Orphan claim re-pointed
Claims processor
CLM-429309 → UHC-31006-41 (Julia Thomas)
Member id
UHC-31006-41
Confidence
1
Method
probabilistic
MBR-005836CLM-429309
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002598
Orphan claim re-pointed
Claims processor
CLM-416421 → UHC-97338-53 (Jean Ortega)
Member id
UHC-97338-53
Confidence
1
Method
probabilistic
MBR-009896CLM-416421
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002599
Orphan claim re-pointed
Claims processor
CLM-408903 → UHC-27788-70 (Marcus Snyder)
Member id
UHC-27788-70
Confidence
1
Method
probabilistic
MBR-013543CLM-408903
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002600
Orphan claim re-pointed
Claims processor
CLM-407376 → UHC-46306-19 (Diana Jacobs)
Member id
UHC-46306-19
Confidence
1
Method
probabilistic
MBR-015575CLM-407376
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002601
Orphan claim re-pointed
Claims processor
CLM-425201 → UHC-86751-24 (Jean Gonzales)
Member id
UHC-86751-24
Confidence
1
Method
probabilistic
MBR-029861CLM-425201
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002602
Orphan claim re-pointed
Claims processor
CLM-400667 → UHC-05200-44 (Brandon Carlson)
Member id
UHC-05200-44
Confidence
1
Method
probabilistic
MBR-018558CLM-400667
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002603
Orphan claim re-pointed
Claims processor
CLM-410215 → UHC-94532-50 (Gary West)
Member id
UHC-94532-50
Confidence
1
Method
probabilistic
MBR-000246CLM-410215
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002604
Orphan claim re-pointed
Claims processor
CLM-420628 → UHC-95518-50 (Stephanie Ross)
Member id
UHC-95518-50
Confidence
0.99
Method
probabilistic
MBR-000350CLM-420628
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002605
Orphan claim re-pointed
Claims processor
CLM-422817 → UHC-88098-43 (Cheryl Barnes)
Member id
UHC-88098-43
Confidence
1
Method
probabilistic
MBR-017169CLM-422817
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002606
Orphan claim re-pointed
Claims processor
CLM-401567 → UHC-32594-17 (Mei Sullivan)
Member id
UHC-32594-17
Confidence
1
Method
probabilistic
MBR-029899CLM-401567
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002607
Orphan claim re-pointed
Claims processor
CLM-407117 → UHC-06338-10 (Sharon Rogers)
Member id
UHC-06338-10
Confidence
0.97
Method
deterministic
MBR-032035CLM-407117
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002608
Orphan claim re-pointed
Claims processor
CLM-418504 → UHC-77781-56 (Ralph Montgomery)
Member id
UHC-77781-56
Confidence
1
Method
probabilistic
MBR-006999CLM-418504
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002609
Orphan claim re-pointed
Claims processor
CLM-404820 → UHC-77984-19 (Steven Estrada)
Member id
UHC-77984-19
Confidence
1
Method
probabilistic
MBR-018073CLM-404820
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002610
Orphan claim re-pointed
Claims processor
CLM-403246 → UHC-66774-91 (Kenneth Martinez)
Member id
UHC-66774-91
Confidence
1
Method
probabilistic
MBR-016078CLM-403246
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002611
Orphan claim re-pointed
Claims processor
CLM-401832 → UHC-16187-17 (Ryan Brooks)
Member id
UHC-16187-17
Confidence
1
Method
probabilistic
MBR-006907CLM-401832
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002612
Orphan claim re-pointed
Claims processor
CLM-408865 → UHC-20763-80 (Michelle Bowman)
Member id
UHC-20763-80
Confidence
1
Method
probabilistic
MBR-014576CLM-408865
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002613
Orphan claim re-pointed
Claims processor
CLM-429324 → UHC-62701-47 (Jordan Robertson)
Member id
UHC-62701-47
Confidence
1
Method
probabilistic
MBR-032746CLM-429324
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002614
Orphan claim re-pointed
Claims processor
CLM-406036 → UHC-76599-05 (Larry Barnes)
Member id
UHC-76599-05
Confidence
0.99
Method
probabilistic
MBR-024690CLM-406036
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002615
Orphan claim re-pointed
Claims processor
CLM-431792 → UHC-80014-17 (Diego Porter)
Member id
UHC-80014-17
Confidence
1
Method
probabilistic
MBR-002808CLM-431792
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002616
Orphan claim re-pointed
Claims processor
CLM-412137 → UHC-35606-69 (Catherine Willis)
Member id
UHC-35606-69
Confidence
0.98
Method
probabilistic
MBR-017248CLM-412137
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002617
Orphan claim re-pointed
Claims processor
CLM-427918 → UHC-13847-83 (Diego Ray)
Member id
UHC-13847-83
Confidence
1
Method
probabilistic
MBR-010093CLM-427918
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002618
Orphan claim re-pointed
Claims processor
CLM-409909 → UHC-84332-87 (Jordan Fowler)
Member id
UHC-84332-87
Confidence
1
Method
probabilistic
MBR-003834CLM-409909
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002619
Orphan claim re-pointed
Claims processor
CLM-424885 → UHC-64131-81 (Kelly Carpenter)
Member id
UHC-64131-81
Confidence
1
Method
probabilistic
MBR-005648CLM-424885
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002620
Orphan claim re-pointed
Claims processor
CLM-409694 → UHC-88199-27 (Carlos Chavez)
Member id
UHC-88199-27
Confidence
1
Method
probabilistic
MBR-002793CLM-409694
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002621
Orphan claim re-pointed
Claims processor
CLM-406960 → UHC-40675-56 (Nicole Daniels)
Member id
UHC-40675-56
Confidence
1
Method
probabilistic
MBR-024637CLM-406960
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002622
Orphan claim re-pointed
Claims processor
CLM-425080 → UHC-20983-31 (Peter Smith)
Member id
UHC-20983-31
Confidence
1
Method
probabilistic
MBR-027791CLM-425080
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002623
Orphan claim re-pointed
Claims processor
CLM-415367 → UHC-75069-05 (Daniel Warren)
Member id
UHC-75069-05
Confidence
0.97
Method
deterministic
MBR-015842CLM-415367
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002624
Orphan claim re-pointed
Claims processor
CLM-430227 → UHC-66078-28 (Aisha Gray)
Member id
UHC-66078-28
Confidence
0.93
Method
probabilistic
MBR-022080CLM-430227
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002625
Orphan claim re-pointed
Claims processor
CLM-426714 → UHC-34406-02 (Patricia Hicks)
Member id
UHC-34406-02
Confidence
1
Method
probabilistic
MBR-028080CLM-426714
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002626
Orphan claim re-pointed
Claims processor
CLM-413566 → UHC-50765-80 (Kathryn Martin)
Member id
UHC-50765-80
Confidence
1
Method
probabilistic
MBR-027411CLM-413566
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002627
Orphan claim re-pointed
Claims processor
CLM-426179 → UHC-26224-70 (Jose Hunter)
Member id
UHC-26224-70
Confidence
0.99
Method
probabilistic
MBR-000947CLM-426179
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002628
Orphan claim re-pointed
Claims processor
CLM-425593 → UHC-44943-48 (Sandra Davis)
Member id
UHC-44943-48
Confidence
0.97
Method
deterministic
MBR-021852CLM-425593
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002629
Orphan claim re-pointed
Claims processor
CLM-405239 → UHC-84143-49 (Anthony Guerrero)
Member id
UHC-84143-49
Confidence
0.98
Method
probabilistic
MBR-006507CLM-405239
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002630
Orphan claim re-pointed
Claims processor
CLM-410917 → UHC-81632-20 (Teresa Payne)
Member id
UHC-81632-20
Confidence
1
Method
probabilistic
MBR-005314CLM-410917
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002631
Orphan claim re-pointed
Claims processor
CLM-420378 → UHC-36461-68 (Sandra Reyes)
Member id
UHC-36461-68
Confidence
1
Method
probabilistic
MBR-018376CLM-420378
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002632
Orphan claim re-pointed
Claims processor
CLM-400276 → UHC-92974-96 (Alexander Medina)
Member id
UHC-92974-96
Confidence
1
Method
probabilistic
MBR-015167CLM-400276
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002633
Orphan claim re-pointed
Claims processor
CLM-419285 → UHC-03266-71 (Amber Munoz)
Member id
UHC-03266-71
Confidence
1
Method
probabilistic
MBR-011086CLM-419285
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002634
Orphan claim re-pointed
Claims processor
CLM-431822 → UHC-99457-20 (Jess Henderson)
Member id
UHC-99457-20
Confidence
1.00
Method
probabilistic
MBR-010508CLM-431822
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002635
Orphan claim re-pointed
Claims processor
CLM-423051 → UHC-16447-67 (Ralph Washington)
Member id
UHC-16447-67
Confidence
1
Method
probabilistic
MBR-003071CLM-423051
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002636
Orphan claim re-pointed
Claims processor
CLM-415973 → UHC-40173-47 (Christina Bishop)
Member id
UHC-40173-47
Confidence
1
Method
probabilistic
MBR-003095CLM-415973
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002637
Orphan claim re-pointed
Claims processor
CLM-405446 → UHC-69418-07 (Cheryl Hill)
Member id
UHC-69418-07
Confidence
1
Method
probabilistic
MBR-017412CLM-405446
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002638
Orphan claim re-pointed
Claims processor
CLM-411704 → UHC-50301-63 (Zachary Henry)
Member id
UHC-50301-63
Confidence
0.98
Method
probabilistic
MBR-031842CLM-411704
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002639
Orphan claim re-pointed
Claims processor
CLM-424754 → UHC-17288-43 (Scott Singh)
Member id
UHC-17288-43
Confidence
1
Method
probabilistic
MBR-010664CLM-424754
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 26 of 282PreviousNext

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.