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-006312 | Orphan claim re-pointed Claims processor | CLM-417713 → UHC-34891-72 (Lori Contreras) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006313 | Orphan claim re-pointed Claims processor | CLM-427340 → UHC-63493-18 (Brian Adams) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006314 | Orphan claim re-pointed Claims processor | CLM-406978 → UHC-98002-75 (Ralph Howell) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006315 | Orphan claim re-pointed Claims processor | CLM-402319 → UHC-29266-34 (Alan Rice) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006316 | Orphan claim re-pointed Claims processor | CLM-428930 → UHC-14551-01 (Sean Miller) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006317 | Orphan claim re-pointed Claims processor | CLM-408314 → UHC-29708-97 (Tyler Ross) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006318 | Orphan claim re-pointed Claims processor | CLM-408214 → UHC-58932-47 (Jean Ford) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006319 | Orphan claim re-pointed Claims processor | CLM-422544 → UHC-05896-07 (Jonathan Sanchez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006320 | Orphan claim re-pointed Claims processor | CLM-418454 → UHC-65651-73 (Jordan Hill) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006321 | Orphan claim re-pointed Claims processor | CLM-417593 → UHC-92828-80 (James Mejia) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006322 | Orphan claim re-pointed Claims processor | CLM-425357 → UHC-22917-70 (Patricia Garza) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006323 | Orphan claim re-pointed Claims processor | CLM-430202 → UHC-90961-55 (Gabriel Patel) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006324 | Orphan claim re-pointed Claims processor | CLM-403768 → UHC-10935-86 (Amber Nichols) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006325 | Orphan claim re-pointed Claims processor | CLM-412717 → UHC-83353-54 (Justin Wilson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006326 | Orphan claim re-pointed Claims processor | CLM-410601 → UHC-74026-83 (Paul Bailey) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006327 | Orphan claim re-pointed Claims processor | CLM-418578 → UHC-44307-53 (Keith Hicks) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006328 | Orphan claim re-pointed Claims processor | CLM-427940 → UHC-16525-76 (Christina Fields) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006329 | Orphan claim re-pointed Claims processor | CLM-402552 → UHC-61498-82 (Sara Riley) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006330 | Orphan claim re-pointed Claims processor | CLM-427239 → UHC-80971-11 (Russell King) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006331 | Orphan claim re-pointed Claims processor | CLM-413154 → UHC-11544-93 (Aaron Rojas) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006332 | Orphan claim re-pointed Claims processor | CLM-425449 → UHC-49523-70 (Judy Snyder) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006333 | Orphan claim re-pointed Claims processor | CLM-402533 → UHC-23088-75 (Andrea Cook) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006334 | Orphan claim re-pointed Claims processor | CLM-425319 → UHC-95632-60 (Gerald Russell) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006335 | Orphan claim re-pointed Claims processor | CLM-400964 → UHC-11904-51 (Betty Pena) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006336 | Orphan claim re-pointed Claims processor | CLM-425884 → UHC-34809-40 (Raymond Jenkins) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006337 | Orphan claim re-pointed Claims processor | CLM-418952 → UHC-97434-51 (Omar Hunt) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006338 | Orphan claim re-pointed Claims processor | CLM-421636 → UHC-59116-79 (Willie Wang) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006339 | Orphan claim re-pointed Claims processor | CLM-429179 → UHC-31006-11 (Megan Richardson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006340 | Orphan claim re-pointed Claims processor | CLM-427200 → UHC-75238-63 (Sharon Black) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006341 | Orphan claim re-pointed Claims processor | CLM-406656 → UHC-33854-74 (Alexander Rose) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006342 | Orphan claim re-pointed Claims processor | CLM-426460 → UHC-39422-61 (Cynthia Carlson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006343 | Orphan claim re-pointed Claims processor | CLM-400889 → UHC-77591-05 (Fatima Kennedy) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006344 | Orphan claim re-pointed Claims processor | CLM-415018 → UHC-79863-33 (Kayla Graham) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006345 | Orphan claim re-pointed Claims processor | CLM-428249 → UHC-22617-37 (Mark Ferguson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006346 | Orphan claim re-pointed Claims processor | CLM-431466 → UHC-67088-66 (Lori Mason) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006347 | Orphan claim re-pointed Claims processor | CLM-422080 → UHC-20467-09 (Omar Thomas) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006348 | Orphan claim re-pointed Claims processor | CLM-421100 → UHC-59343-89 (Ryan Li) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006349 | Orphan claim re-pointed Claims processor | CLM-421192 → UHC-63850-64 (Sara Wood) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006350 | Orphan claim re-pointed Claims processor | CLM-409904 → UHC-88592-44 (Amber Howell) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006351 | Orphan claim re-pointed Claims processor | CLM-431913 → UHC-90571-23 (Michelle Gutierrez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006352 | Orphan claim re-pointed Claims processor | CLM-404798 → UHC-06894-24 (Billy Gibson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006353 | Orphan claim re-pointed Claims processor | CLM-414130 → UHC-09912-57 (Albert Mason) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006354 | Orphan claim re-pointed Claims processor | CLM-416071 → UHC-43281-15 (Angela Anderson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006355 | Orphan claim re-pointed Claims processor | CLM-409664 → UHC-08254-58 (Timothy Welch) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006356 | Orphan claim re-pointed Claims processor | CLM-419722 → UHC-19329-14 (Theresa Ruiz) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006357 | Orphan claim re-pointed Claims processor | CLM-406658 → UHC-97895-99 (Ronald Collins) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006358 | Orphan claim re-pointed Claims processor | CLM-403569 → UHC-54035-72 (Dennis Larson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006359 | Orphan claim re-pointed Claims processor | CLM-427956 → UHC-30017-27 (Laura Wagner) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006360 | Orphan claim re-pointed Claims processor | CLM-425116 → UHC-19173-70 (Sean Larson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006361 | Orphan claim re-pointed Claims processor | CLM-401654 → UHC-96066-30 (Henry Powell) |
| 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.