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-006412 | Orphan claim re-pointed Claims processor | CLM-420926 → UHC-18704-10 (Pamela Arnold) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006413 | Orphan claim re-pointed Claims processor | CLM-408144 → UHC-98486-13 (Charlotte Simmons) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006414 | Orphan claim re-pointed Claims processor | CLM-414285 → UHC-62910-31 (Megan Watson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006415 | Orphan claim re-pointed Claims processor | CLM-411035 → UHC-24941-46 (Arjun Schmidt) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006416 | Orphan claim re-pointed Claims processor | CLM-418491 → UHC-39290-06 (Linda Kelly) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006417 | Orphan claim re-pointed Claims processor | CLM-429415 → UHC-76690-56 (Douglas Lewis) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006418 | Orphan claim re-pointed Claims processor | CLM-423295 → UHC-86873-43 (Adam Wood) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006419 | Orphan claim re-pointed Claims processor | CLM-426765 → UHC-82369-83 (Katherine Bryant) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006420 | Orphan claim re-pointed Claims processor | CLM-400184 → UHC-36965-72 (Anthony Ross) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006421 | Orphan claim re-pointed Claims processor | CLM-417996 → UHC-25155-17 (Ana Gant) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006422 | Orphan claim re-pointed Claims processor | CLM-425645 → UHC-54707-20 (Roy Brooks) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006423 | Orphan claim re-pointed Claims processor | CLM-410934 → UHC-51170-46 (Jesse Warren) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006424 | Orphan claim re-pointed Claims processor | CLM-417893 → UHC-17587-12 (Justin Tran) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006425 | Orphan claim re-pointed Claims processor | CLM-417773 → UHC-01095-30 (Kathleen Gardner) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006426 | Orphan claim re-pointed Claims processor | CLM-401831 → UHC-16187-17 (Ryan Brooks) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006427 | Orphan claim re-pointed Claims processor | CLM-427706 → UHC-52666-57 (Elijah Matthews) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006428 | Orphan claim re-pointed Claims processor | CLM-422826 → UHC-88575-02 (Theresa Duncan) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006429 | Orphan claim re-pointed Claims processor | CLM-427616 → UHC-70116-01 (Matthew Walker) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006430 | Orphan claim re-pointed Claims processor | CLM-403535 → UHC-30904-19 (Kevin Turner) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006431 | Orphan claim re-pointed Claims processor | CLM-405692 → UHC-87845-70 (Santiago Mendoza) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006432 | Orphan claim re-pointed Claims processor | CLM-403091 → UHC-81250-72 (Patricia Miller) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006433 | Orphan claim re-pointed Claims processor | CLM-432774 → UHC-47935-63 (Barb Weber) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006434 | Orphan claim re-pointed Claims processor | CLM-407267 → UHC-62055-42 (Kenneth Gordon) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006435 | Orphan claim re-pointed Claims processor | CLM-415106 → UHC-64207-18 (Emma White) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006436 | Orphan claim re-pointed Claims processor | CLM-421257 → UHC-61130-89 (Dorothy Bradley) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006437 | Orphan claim re-pointed Claims processor | CLM-409445 → UHC-23755-18 (James Hunter) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006438 | Orphan claim re-pointed Claims processor | CLM-409837 → UHC-15476-72 (Joe Hernandez) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006439 | Orphan claim re-pointed Claims processor | CLM-412008 → UHC-28458-04 (Gerald Jones) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006440 | Orphan claim re-pointed Claims processor | CLM-416575 → UHC-59122-39 (Ethan Welch) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006441 | Orphan claim re-pointed Claims processor | CLM-418994 → UHC-36349-47 (Aisha Stone) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006442 | Orphan claim re-pointed Claims processor | CLM-420072 → UHC-78090-69 (Christine Olson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006443 | Orphan claim re-pointed Claims processor | CLM-423054 → UHC-16434-80 (Ken Harvey) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006444 | Orphan claim re-pointed Claims processor | CLM-416873 → UHC-81733-66 (Albert Santos) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006445 | Orphan claim re-pointed Claims processor | CLM-419174 → UHC-24432-65 (Russell Cunningham) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006446 | Orphan claim re-pointed Claims processor | CLM-407463 → UHC-68356-50 (Ana Hunter) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006447 | Orphan claim re-pointed Claims processor | CLM-409230 → UHC-28152-67 (Joe Castillo) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006448 | Orphan claim re-pointed Claims processor | CLM-414561 → UHC-39796-37 (Hanson Margaret) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006449 | Orphan claim re-pointed Claims processor | CLM-419685 → UHC-76302-57 (Diego Nguyen) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006450 | Orphan claim re-pointed Claims processor | CLM-410816 → UHC-19980-14 (Stephen Graham) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006451 | Orphan claim re-pointed Claims processor | CLM-432041 → UHC-39291-32 (Santiago Burton) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006452 | Orphan claim re-pointed Claims processor | CLM-410684 → UHC-82828-61 (Teresa Gonzales) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006453 | Orphan claim re-pointed Claims processor | CLM-431402 → UHC-27209-51 (Gary Matthews) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006454 | Orphan claim re-pointed Claims processor | CLM-420937 → UHC-74540-84 (Judith Soto) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006455 | Orphan claim re-pointed Claims processor | CLM-429935 → UHC-24155-05 (Walter Flores) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006456 | Orphan claim re-pointed Claims processor | CLM-403869 → UHC-64030-81 (Kyle Wong) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006457 | Orphan claim re-pointed Claims processor | CLM-411014 → UHC-42385-49 (Brittany Elliott) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006458 | Orphan claim re-pointed Claims processor | CLM-417649 → UHC-50958-96 (Jacob Walker) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006459 | Orphan claim re-pointed Claims processor | CLM-400629 → UHC-81966-47 (Alexander Thompson) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006460 | Orphan claim re-pointed Claims processor | CLM-422747 → UHC-73785-46 (Elizabeth Reyes) |
| Executed | resolution_agent 2026-10-22 12:47:23 | ||
| ACT-006461 | Orphan claim re-pointed Claims processor | CLM-410146 → UHC-13273-59 (Theresa Diaz) |
| 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.