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-002690
Orphan claim re-pointed
Claims processor
CLM-406329 → UHC-91616-29 (Susan Cruz)
Member id
UHC-91616-29
Confidence
1
Method
probabilistic
MBR-014172CLM-406329
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002691
Orphan claim re-pointed
Claims processor
CLM-425469 → UHC-53604-06 (Steven Ramos)
Member id
UHC-53604-06
Confidence
1
Method
probabilistic
MBR-008981CLM-425469
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002692
Orphan claim re-pointed
Claims processor
CLM-429993 → UHC-17287-55 (Terry Henderson)
Member id
UHC-17287-55
Confidence
0.97
Method
deterministic
MBR-010560CLM-429993
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002693
Orphan claim re-pointed
Claims processor
CLM-400729 → UHC-76291-34 (Jacob Grant)
Member id
UHC-76291-34
Confidence
1
Method
probabilistic
MBR-020476CLM-400729
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002694
Orphan claim re-pointed
Claims processor
CLM-418295 → UHC-97403-22 (Angela Matthews)
Member id
UHC-97403-22
Confidence
1
Method
probabilistic
MBR-031136CLM-418295
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002695
Orphan claim re-pointed
Claims processor
CLM-416236 → UHC-02195-39 (Gloria Harper)
Member id
UHC-02195-39
Confidence
0.99
Method
probabilistic
MBR-014309CLM-416236
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002696
Orphan claim re-pointed
Claims processor
CLM-432609 → UHC-25299-76 (Christina Williams)
Member id
UHC-25299-76
Confidence
1
Method
probabilistic
MBR-028438CLM-432609
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002697
Orphan claim re-pointed
Claims processor
CLM-406300 → UHC-68741-60 (Joyce Palmer)
Member id
UHC-68741-60
Confidence
1
Method
probabilistic
MBR-003453CLM-406300
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002698
Orphan claim re-pointed
Claims processor
CLM-402802 → UHC-56451-68 (Kimberly Rios)
Member id
UHC-56451-68
Confidence
1
Method
probabilistic
MBR-030597CLM-402802
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002699
Orphan claim re-pointed
Claims processor
CLM-403067 → UHC-67952-99 (Alexis Garza)
Member id
UHC-67952-99
Confidence
1
Method
probabilistic
MBR-015676CLM-403067
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002700
Orphan claim re-pointed
Claims processor
CLM-423662 → UHC-58068-44 (Bobby Luna)
Member id
UHC-58068-44
Confidence
1
Method
probabilistic
MBR-019073CLM-423662
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002701
Orphan claim re-pointed
Claims processor
CLM-416134 → UHC-67936-93 (Emma Park)
Member id
UHC-67936-93
Confidence
0.99
Method
probabilistic
MBR-010195CLM-416134
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002702
Orphan claim re-pointed
Claims processor
CLM-425320 → UHC-95632-60 (Gerald Russell)
Member id
UHC-95632-60
Confidence
1
Method
probabilistic
MBR-000568CLM-425320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002703
Orphan claim re-pointed
Claims processor
CLM-414682 → UHC-78624-36 (Edward Chapman)
Member id
UHC-78624-36
Confidence
1
Method
probabilistic
MBR-025617CLM-414682
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002704
Orphan claim re-pointed
Claims processor
CLM-407664 → UHC-74632-47 (Christopher Bowman)
Member id
UHC-74632-47
Confidence
0.97
Method
deterministic
MBR-008362CLM-407664
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002705
Orphan claim re-pointed
Claims processor
CLM-430833 → UHC-52083-96 (Jesse Kim)
Member id
UHC-52083-96
Confidence
1
Method
probabilistic
MBR-004548CLM-430833
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002706
Orphan claim re-pointed
Claims processor
CLM-407087 → UHC-44422-88 (Ralph Daniels)
Member id
UHC-44422-88
Confidence
1
Method
probabilistic
MBR-000036CLM-407087
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002707
Orphan claim re-pointed
Claims processor
CLM-401259 → UHC-59285-16 (Nancy Delgado)
Member id
UHC-59285-16
Confidence
1
Method
probabilistic
MBR-003675CLM-401259
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002708
Orphan claim re-pointed
Claims processor
CLM-417345 → UHC-37551-83 (Ana Mason)
Member id
UHC-37551-83
Confidence
1
Method
probabilistic
MBR-020341CLM-417345
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002709
Orphan claim re-pointed
Claims processor
CLM-404809 → UHC-63795-99 (Michelle Fowler)
Member id
UHC-63795-99
Confidence
1
Method
probabilistic
MBR-028157CLM-404809
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002710
Orphan claim re-pointed
Claims processor
CLM-411743 → UHC-34549-49 (Albert Guzman)
Member id
UHC-34549-49
Confidence
0.94
Method
probabilistic
MBR-022651CLM-411743
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002711
Orphan claim re-pointed
Claims processor
CLM-419359 → UHC-61304-66 (Samantha Burns)
Member id
UHC-61304-66
Confidence
1
Method
probabilistic
MBR-028093CLM-419359
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002712
Orphan claim re-pointed
Claims processor
CLM-424166 → UHC-44839-36 (Mark Reyes)
Member id
UHC-44839-36
Confidence
1
Method
probabilistic
MBR-011567CLM-424166
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002713
Orphan claim re-pointed
Claims processor
CLM-426208 → UHC-77199-91 (Kyle Lawrence)
Member id
UHC-77199-91
Confidence
1
Method
probabilistic
MBR-006035CLM-426208
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002714
Orphan claim re-pointed
Claims processor
CLM-428450 → UHC-20288-13 (Heather Jackson)
Member id
UHC-20288-13
Confidence
0.97
Method
deterministic
MBR-018019CLM-428450
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002715
Orphan claim re-pointed
Claims processor
CLM-402226 → UHC-74636-77 (Alice Singh)
Member id
UHC-74636-77
Confidence
0.93
Method
probabilistic
MBR-008825CLM-402226
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002716
Orphan claim re-pointed
Claims processor
CLM-418765 → UHC-54913-54 (Tyler Vargas)
Member id
UHC-54913-54
Confidence
0.94
Method
probabilistic
MBR-013478CLM-418765
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002717
Orphan claim re-pointed
Claims processor
CLM-400599 → UHC-95609-38 (Kayla McDonald)
Member id
UHC-95609-38
Confidence
1
Method
probabilistic
MBR-037828CLM-400599
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002718
Orphan claim re-pointed
Claims processor
CLM-432085 → UHC-43805-72 (William Wells)
Member id
UHC-43805-72
Confidence
0.99
Method
probabilistic
MBR-015157CLM-432085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002719
Orphan claim re-pointed
Claims processor
CLM-429564 → UHC-71882-37 (Robert Robinson)
Member id
UHC-71882-37
Confidence
1
Method
probabilistic
MBR-000165CLM-429564
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002720
Orphan claim re-pointed
Claims processor
CLM-432075 → UHC-67683-28 (Emily Shaw)
Member id
UHC-67683-28
Confidence
1
Method
probabilistic
MBR-001486CLM-432075
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002721
Orphan claim re-pointed
Claims processor
CLM-426389 → UHC-69005-94 (Debra Sullivan)
Member id
UHC-69005-94
Confidence
1
Method
probabilistic
MBR-001663CLM-426389
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002722
Orphan claim re-pointed
Claims processor
CLM-427580 → UHC-53260-05 (Ralph Peterson)
Member id
UHC-53260-05
Confidence
1
Method
probabilistic
MBR-006611CLM-427580
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002723
Orphan claim re-pointed
Claims processor
CLM-410965 → UHC-16525-11 (Angela Vargas)
Member id
UHC-16525-11
Confidence
1
Method
probabilistic
MBR-004078CLM-410965
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002724
Orphan claim re-pointed
Claims processor
CLM-417073 → UHC-24476-29 (Hannah Williams)
Member id
UHC-24476-29
Confidence
1
Method
probabilistic
MBR-000004CLM-417073
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002725
Orphan claim re-pointed
Claims processor
CLM-427757 → UHC-02487-95 (Dennis Kelly)
Member id
UHC-02487-95
Confidence
1
Method
probabilistic
MBR-016016CLM-427757
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002726
Orphan claim re-pointed
Claims processor
CLM-400506 → UHC-03740-18 (William Ferguson)
Member id
UHC-03740-18
Confidence
1
Method
probabilistic
MBR-009687CLM-400506
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002727
Orphan claim re-pointed
Claims processor
CLM-406397 → UHC-04319-84 (Barbara Simpson)
Member id
UHC-04319-84
Confidence
1
Method
probabilistic
MBR-011042CLM-406397
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002728
Orphan claim re-pointed
Claims processor
CLM-424635 → UHC-40221-33 (Dylan Welch)
Member id
UHC-40221-33
Confidence
1
Method
probabilistic
MBR-025816CLM-424635
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002729
Orphan claim re-pointed
Claims processor
CLM-413132 → UHC-47460-74 (Steven Kelly)
Member id
UHC-47460-74
Confidence
0.97
Method
deterministic
MBR-019109CLM-413132
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002730
Orphan claim re-pointed
Claims processor
CLM-432080 → UHC-79111-93 (Scott Campbell)
Member id
UHC-79111-93
Confidence
1
Method
probabilistic
MBR-028283CLM-432080
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002731
Orphan claim re-pointed
Claims processor
CLM-416782 → UHC-87829-83 (Karen Meyer)
Member id
UHC-87829-83
Confidence
1
Method
probabilistic
MBR-007387CLM-416782
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002732
Orphan claim re-pointed
Claims processor
CLM-412804 → UHC-32846-70 (Jesse Stevens)
Member id
UHC-32846-70
Confidence
0.97
Method
deterministic
MBR-041042CLM-412804
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002733
Orphan claim re-pointed
Claims processor
CLM-423589 → UHC-44191-84 (Kevin Singh)
Member id
UHC-44191-84
Confidence
0.97
Method
deterministic
MBR-004924CLM-423589
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002734
Orphan claim re-pointed
Claims processor
CLM-417819 → UHC-14494-39 (Sharon Cox)
Member id
UHC-14494-39
Confidence
0.97
Method
deterministic
MBR-028773CLM-417819
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002735
Orphan claim re-pointed
Claims processor
CLM-404601 → UHC-72403-52 (Russell Elliott)
Member id
UHC-72403-52
Confidence
1
Method
probabilistic
MBR-019098CLM-404601
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002736
Orphan claim re-pointed
Claims processor
CLM-409624 → UHC-22515-20 (Bruce Adams)
Member id
UHC-22515-20
Confidence
0.97
Method
deterministic
MBR-034654CLM-409624
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002737
Orphan claim re-pointed
Claims processor
CLM-407609 → UHC-88336-76 (Richard Washington)
Member id
UHC-88336-76
Confidence
1
Method
probabilistic
MBR-034353CLM-407609
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002738
Orphan claim re-pointed
Claims processor
CLM-419247 → UHC-20089-46 (Sophia Bell)
Member id
UHC-20089-46
Confidence
0.93
Method
probabilistic
MBR-027431CLM-419247
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002739
Orphan claim re-pointed
Claims processor
CLM-417820 → UHC-02024-63 (Rachel Knight)
Member id
UHC-02024-63
Confidence
0.97
Method
deterministic
MBR-032025CLM-417820
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 28 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.