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-006762
Orphan claim re-pointed
Claims processor
CLM-426486 → UHC-54492-80 (Jesse Freeman)
Member id
UHC-54492-80
Confidence
1
Method
probabilistic
MBR-012624CLM-426486
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006763
Orphan claim re-pointed
Claims processor
CLM-420202 → UHC-63561-95 (Alexis Armstrong)
Member id
UHC-63561-95
Confidence
0.97
Method
deterministic
MBR-005579CLM-420202
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006764
Orphan claim re-pointed
Claims processor
CLM-424812 → UHC-96827-16 (Daniel Green)
Member id
UHC-96827-16
Confidence
0.97
Method
deterministic
MBR-012142CLM-424812
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006765
Orphan claim re-pointed
Claims processor
CLM-401839 → UHC-14204-71 (Hiroshi Reynolds)
Member id
UHC-14204-71
Confidence
1
Method
probabilistic
MBR-033076CLM-401839
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006766
Orphan claim re-pointed
Claims processor
CLM-422578 → UHC-66106-28 (Thomas Santos)
Member id
UHC-66106-28
Confidence
0.97
Method
deterministic
MBR-034074CLM-422578
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006767
Orphan claim re-pointed
Claims processor
CLM-428153 → UHC-03625-33 (Gloria Yang)
Member id
UHC-03625-33
Confidence
0.93
Method
probabilistic
MBR-002474CLM-428153
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006768
Orphan claim re-pointed
Claims processor
CLM-423234 → UHC-08296-83 (Jeremy Hanson)
Member id
UHC-08296-83
Confidence
1
Method
probabilistic
MBR-021658CLM-423234
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006769
Orphan claim re-pointed
Claims processor
CLM-428204 → UHC-04373-65 (Andrea Reyes)
Member id
UHC-04373-65
Confidence
1
Method
probabilistic
MBR-004250CLM-428204
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006770
Orphan claim re-pointed
Claims processor
CLM-418205 → UHC-92780-76 (Sharon Fowler)
Member id
UHC-92780-76
Confidence
1
Method
probabilistic
MBR-020027CLM-418205
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006771
Orphan claim re-pointed
Claims processor
CLM-414734 → UHC-17061-12 (Shirley Alvarez)
Member id
UHC-17061-12
Confidence
1
Method
probabilistic
MBR-042032CLM-414734
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006772
Orphan claim re-pointed
Claims processor
CLM-425407 → UHC-57765-55 (Kelly Herrera)
Member id
UHC-57765-55
Confidence
1
Method
probabilistic
MBR-025064CLM-425407
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006773
Orphan claim re-pointed
Claims processor
CLM-418475 → UHC-01651-17 (Ana Ward)
Member id
UHC-01651-17
Confidence
1
Method
probabilistic
MBR-030728CLM-418475
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006774
Orphan claim re-pointed
Claims processor
CLM-431267 → UHC-15710-14 (Alice Ortiz)
Member id
UHC-15710-14
Confidence
1
Method
probabilistic
MBR-000574CLM-431267
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006775
Orphan claim re-pointed
Claims processor
CLM-404262 → UHC-18244-83 (Beverly Cruz)
Member id
UHC-18244-83
Confidence
0.99
Method
probabilistic
MBR-000487CLM-404262
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006776
Orphan claim re-pointed
Claims processor
CLM-421581 → UHC-19189-76 (Tyler Maldonado)
Member id
UHC-19189-76
Confidence
1
Method
probabilistic
MBR-011078CLM-421581
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006777
Orphan claim re-pointed
Claims processor
CLM-409945 → UHC-04770-46 (Lucia Woods)
Member id
UHC-04770-46
Confidence
0.99
Method
probabilistic
MBR-018482CLM-409945
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006778
Orphan claim re-pointed
Claims processor
CLM-424304 → UHC-83799-46 (Ryan Reed)
Member id
UHC-83799-46
Confidence
1
Method
probabilistic
MBR-029483CLM-424304
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006779
Orphan claim re-pointed
Claims processor
CLM-417740 → UHC-66759-58 (Olivia Duncan)
Member id
UHC-66759-58
Confidence
1
Method
probabilistic
MBR-002561CLM-417740
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006780
Orphan claim re-pointed
Claims processor
CLM-418937 → UHC-17261-98 (Eugene Fuller)
Member id
UHC-17261-98
Confidence
1
Method
probabilistic
MBR-020480CLM-418937
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006781
Orphan claim re-pointed
Claims processor
CLM-404712 → UHC-84483-96 (Mary Austin)
Member id
UHC-84483-96
Confidence
0.90
Method
probabilistic
MBR-040635CLM-404712
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006782
Orphan claim re-pointed
Claims processor
CLM-423035 → UHC-45067-31 (Camila Guerrero)
Member id
UHC-45067-31
Confidence
1
Method
probabilistic
MBR-010489CLM-423035
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006783
Orphan claim re-pointed
Claims processor
CLM-417817 → UHC-39422-02 (Amy Ferguson)
Member id
UHC-39422-02
Confidence
1
Method
probabilistic
MBR-017763CLM-417817
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006784
Orphan claim re-pointed
Claims processor
CLM-416443 → UHC-65456-50 (Janice Ramos)
Member id
UHC-65456-50
Confidence
1
Method
probabilistic
MBR-011714CLM-416443
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006785
Orphan claim re-pointed
Claims processor
CLM-426716 → UHC-21038-92 (Melissa Butler)
Member id
UHC-21038-92
Confidence
0.99
Method
probabilistic
MBR-034075CLM-426716
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006786
Orphan claim re-pointed
Claims processor
CLM-417018 → UHC-62623-61 (Jean Andrews)
Member id
UHC-62623-61
Confidence
0.97
Method
deterministic
MBR-009910CLM-417018
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006787
Orphan claim re-pointed
Claims processor
CLM-430940 → UHC-64949-34 (Michelle Bowman)
Member id
UHC-64949-34
Confidence
1
Method
probabilistic
MBR-013784CLM-430940
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006788
Orphan claim re-pointed
Claims processor
CLM-427198 → UHC-41359-99 (Olivia Maldonado)
Member id
UHC-41359-99
Confidence
0.94
Method
probabilistic
MBR-026506CLM-427198
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006789
Orphan claim re-pointed
Claims processor
CLM-416288 → UHC-98234-91 (Bryan Gonzales)
Member id
UHC-98234-91
Confidence
0.97
Method
deterministic
MBR-002737CLM-416288
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006790
Orphan claim re-pointed
Claims processor
CLM-411244 → UHC-67679-87 (Henry Rodriguez)
Member id
UHC-67679-87
Confidence
1
Method
probabilistic
MBR-017300CLM-411244
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006791
Orphan claim re-pointed
Claims processor
CLM-404219 → UHC-42564-49 (Joseph Gray)
Member id
UHC-42564-49
Confidence
0.97
Method
deterministic
MBR-009300CLM-404219
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006792
Orphan claim re-pointed
Claims processor
CLM-406361 → UHC-31605-12 (Lawson Michael)
Member id
UHC-31605-12
Confidence
0.98
Method
probabilistic
MBR-018852CLM-406361
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006793
Orphan claim re-pointed
Claims processor
CLM-410470 → UHC-82854-28 (Juan Santos)
Member id
UHC-82854-28
Confidence
0.97
Method
deterministic
MBR-031100CLM-410470
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006794
Orphan claim re-pointed
Claims processor
CLM-424452 → UHC-50647-01 (Noah Garza)
Member id
UHC-50647-01
Confidence
1
Method
probabilistic
MBR-015665CLM-424452
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006795
Orphan claim re-pointed
Claims processor
CLM-421979 → UHC-10502-17 (Grace Stephens)
Member id
UHC-10502-17
Confidence
1
Method
probabilistic
MBR-002522CLM-421979
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006796
Orphan claim re-pointed
Claims processor
CLM-414608 → UHC-86265-57 (Rachel Perez)
Member id
UHC-86265-57
Confidence
1
Method
probabilistic
MBR-036407CLM-414608
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006797
Orphan claim re-pointed
Claims processor
CLM-405145 → UHC-68210-89 (Alexis Ramirez)
Member id
UHC-68210-89
Confidence
0.97
Method
deterministic
MBR-001796CLM-405145
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006798
Orphan claim re-pointed
Claims processor
CLM-408712 → UHC-79682-77 (John Maldonado)
Member id
UHC-79682-77
Confidence
1
Method
probabilistic
MBR-027222CLM-408712
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006799
Orphan claim re-pointed
Claims processor
CLM-428098 → UHC-81595-06 (Kathleen Hudson)
Member id
UHC-81595-06
Confidence
0.94
Method
probabilistic
MBR-013585CLM-428098
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006800
Orphan claim re-pointed
Claims processor
CLM-431106 → UHC-00981-78 (Sandra Richardson)
Member id
UHC-00981-78
Confidence
0.97
Method
deterministic
MBR-016781CLM-431106
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006801
Orphan claim re-pointed
Claims processor
CLM-413667 → UHC-79675-66 (Stephen Bailey)
Member id
UHC-79675-66
Confidence
1
Method
probabilistic
MBR-042733CLM-413667
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006802
Orphan claim re-pointed
Claims processor
CLM-408176 → UHC-89048-29 (Robert Maldonado)
Member id
UHC-89048-29
Confidence
1
Method
probabilistic
MBR-023182CLM-408176
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006803
Orphan claim re-pointed
Claims processor
CLM-424709 → UHC-98414-49 (Lauren Stone)
Member id
UHC-98414-49
Confidence
1
Method
probabilistic
MBR-018450CLM-424709
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006804
Orphan claim re-pointed
Claims processor
CLM-424733 → UHC-17116-81 (Joseph Olson)
Member id
UHC-17116-81
Confidence
1
Method
probabilistic
MBR-028584CLM-424733
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006805
Orphan claim re-pointed
Claims processor
CLM-409796 → UHC-95154-03 (Christian Weber)
Member id
UHC-95154-03
Confidence
1
Method
probabilistic
MBR-025628CLM-409796
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006806
Orphan claim re-pointed
Claims processor
CLM-421658 → UHC-39030-53 (Kathleen Lynch)
Member id
UHC-39030-53
Confidence
0.97
Method
deterministic
MBR-022993CLM-421658
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006807
Orphan claim re-pointed
Claims processor
CLM-415789 → UHC-83207-26 (Walter Davis)
Member id
UHC-83207-26
Confidence
1
Method
probabilistic
MBR-032531CLM-415789
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006808
Orphan claim re-pointed
Claims processor
CLM-416600 → UHC-68040-19 (Lawrence Williams)
Member id
UHC-68040-19
Confidence
1
Method
probabilistic
MBR-021114CLM-416600
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006809
Orphan claim re-pointed
Claims processor
CLM-429322 → UHC-22405-40 (Harold Green)
Member id
UHC-22405-40
Confidence
1
Method
probabilistic
MBR-017352CLM-429322
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006810
Orphan claim re-pointed
Claims processor
CLM-424150 → UHC-50752-94 (Laura Patterson)
Member id
UHC-50752-94
Confidence
0.97
Method
deterministic
MBR-004912CLM-424150
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006811
Orphan claim re-pointed
Claims processor
CLM-425907 → UHC-75274-21 (Julie Moore)
Member id
UHC-75274-21
Confidence
0.97
Method
deterministic
MBR-023122CLM-425907
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 274 of 533PreviousNext

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.