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-001440
Orphan claim re-pointed
Claims processor
CLM-405033 → UHC-92637-64 (Christopher Cunningham)
Member id
UHC-92637-64
Confidence
0.97
Method
deterministic
MBR-003293CLM-405033
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001441
Orphan claim re-pointed
Claims processor
CLM-403824 → UHC-40594-68 (Scott Schultz)
Member id
UHC-40594-68
Confidence
1
Method
probabilistic
MBR-009986CLM-403824
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001442
Orphan claim re-pointed
Claims processor
CLM-428467 → UHC-23896-63 (Danielle Hayes)
Member id
UHC-23896-63
Confidence
1
Method
probabilistic
MBR-022602CLM-428467
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001443
Orphan claim re-pointed
Claims processor
CLM-429220 → UHC-69901-39 (Aisha Larson)
Member id
UHC-69901-39
Confidence
0.97
Method
deterministic
MBR-024306CLM-429220
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001444
Orphan claim re-pointed
Claims processor
CLM-403173 → UHC-40061-23 (Stephanie Oliver)
Member id
UHC-40061-23
Confidence
0.94
Method
probabilistic
MBR-021879CLM-403173
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001445
Orphan claim re-pointed
Claims processor
CLM-424244 → UHC-82481-95 (Judith Snyder)
Member id
UHC-82481-95
Confidence
1
Method
probabilistic
MBR-026846CLM-424244
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001446
Orphan claim re-pointed
Claims processor
CLM-414278 → UHC-26709-92 (Zachary Watkins)
Member id
UHC-26709-92
Confidence
0.97
Method
deterministic
MBR-000842CLM-414278
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001447
Orphan claim re-pointed
Claims processor
CLM-426166 → UHC-96761-53 (Jeremy Watkins)
Member id
UHC-96761-53
Confidence
1
Method
probabilistic
MBR-007988CLM-426166
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001448
Orphan claim re-pointed
Claims processor
CLM-411191 → UHC-33676-78 (Brandon Bennett)
Member id
UHC-33676-78
Confidence
1
Method
probabilistic
MBR-008565CLM-411191
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001449
Orphan claim re-pointed
Claims processor
CLM-423971 → UHC-07728-57 (Jennifer Medina)
Member id
UHC-07728-57
Confidence
1
Method
probabilistic
MBR-008471CLM-423971
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001450
Orphan claim re-pointed
Claims processor
CLM-415637 → UHC-06408-75 (Dylan Hudson)
Member id
UHC-06408-75
Confidence
1
Method
probabilistic
MBR-003904CLM-415637
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001451
Orphan claim re-pointed
Claims processor
CLM-405226 → UHC-96362-36 (Kayla Wong)
Member id
UHC-96362-36
Confidence
1
Method
probabilistic
MBR-033559CLM-405226
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001452
Orphan claim re-pointed
Claims processor
CLM-406470 → UHC-84368-17 (Stephen Holmes)
Member id
UHC-84368-17
Confidence
1
Method
probabilistic
MBR-007223CLM-406470
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001453
Orphan claim re-pointed
Claims processor
CLM-415628 → UHC-49054-08 (Martha Campbell)
Member id
UHC-49054-08
Confidence
1
Method
probabilistic
MBR-013667CLM-415628
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001454
Orphan claim re-pointed
Claims processor
CLM-419094 → UHC-63825-95 (Helen Estrada)
Member id
UHC-63825-95
Confidence
0.99
Method
probabilistic
MBR-035682CLM-419094
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001455
Orphan claim re-pointed
Claims processor
CLM-409314 → UHC-16964-87 (Douglas Pierce)
Member id
UHC-16964-87
Confidence
1
Method
probabilistic
MBR-022078CLM-409314
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001456
Orphan claim re-pointed
Claims processor
CLM-419299 → UHC-12076-16 (Isabella Walsh)
Member id
UHC-12076-16
Confidence
0.98
Method
probabilistic
MBR-022899CLM-419299
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001457
Orphan claim re-pointed
Claims processor
CLM-427508 → UHC-27327-14 (Brian Matthews)
Member id
UHC-27327-14
Confidence
1
Method
probabilistic
MBR-016134CLM-427508
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001458
Orphan claim re-pointed
Claims processor
CLM-428285 → UHC-09268-29 (Jessica Carroll)
Member id
UHC-09268-29
Confidence
1
Method
probabilistic
MBR-008954CLM-428285
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001459
Orphan claim re-pointed
Claims processor
CLM-432016 → UHC-58249-92 (Bradley Ferguson)
Member id
UHC-58249-92
Confidence
0.97
Method
deterministic
MBR-034698CLM-432016
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001460
Orphan claim re-pointed
Claims processor
CLM-421596 → UHC-83597-11 (Terry Li)
Member id
UHC-83597-11
Confidence
1
Method
probabilistic
MBR-008699CLM-421596
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001461
Orphan claim re-pointed
Claims processor
CLM-415906 → UHC-46707-26 (Nathan Campbell)
Member id
UHC-46707-26
Confidence
1
Method
probabilistic
MBR-008498CLM-415906
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001462
Orphan claim re-pointed
Claims processor
CLM-401719 → UHC-60493-89 (Camila James)
Member id
UHC-60493-89
Confidence
1
Method
probabilistic
MBR-005539CLM-401719
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001463
Orphan claim re-pointed
Claims processor
CLM-432014 → UHC-17803-51 (Arjun Santos)
Member id
UHC-17803-51
Confidence
0.93
Method
probabilistic
MBR-046491CLM-432014
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001464
Orphan claim re-pointed
Claims processor
CLM-401595 → UHC-08965-17 (Melissa Willis)
Member id
UHC-08965-17
Confidence
0.99
Method
probabilistic
MBR-006495CLM-401595
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001465
Orphan claim re-pointed
Claims processor
CLM-411411 → UHC-91238-92 (Kelly Wheeler)
Member id
UHC-91238-92
Confidence
1
Method
probabilistic
MBR-002305CLM-411411
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001466
Orphan claim re-pointed
Claims processor
CLM-401715 → UHC-52048-24 (Andrea Holmes)
Member id
UHC-52048-24
Confidence
1
Method
probabilistic
MBR-001288CLM-401715
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001467
Orphan claim re-pointed
Claims processor
CLM-405794 → UHC-49058-08 (Nathan Moore)
Member id
UHC-49058-08
Confidence
0.97
Method
deterministic
MBR-001599CLM-405794
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001468
Orphan claim re-pointed
Claims processor
CLM-429786 → UHC-38315-81 (Heather Ramirez)
Member id
UHC-38315-81
Confidence
1
Method
probabilistic
MBR-004659CLM-429786
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001469
Orphan claim re-pointed
Claims processor
CLM-422541 → UHC-00344-49 (Ralph Mendoza)
Member id
UHC-00344-49
Confidence
1
Method
probabilistic
MBR-014061CLM-422541
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001470
Orphan claim re-pointed
Claims processor
CLM-422850 → UHC-50392-85 (George Kelley)
Member id
UHC-50392-85
Confidence
1
Method
probabilistic
MBR-023857CLM-422850
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001471
Orphan claim re-pointed
Claims processor
CLM-423601 → UHC-10065-30 (Aaron Rojas)
Member id
UHC-10065-30
Confidence
1
Method
probabilistic
MBR-003902CLM-423601
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001472
Orphan claim re-pointed
Claims processor
CLM-429059 → UHC-69955-67 (Arjun Hudson)
Member id
UHC-69955-67
Confidence
1
Method
probabilistic
MBR-022011CLM-429059
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001473
Orphan claim re-pointed
Claims processor
CLM-404214 → UHC-78491-23 (Janice Clark)
Member id
UHC-78491-23
Confidence
1
Method
probabilistic
MBR-013540CLM-404214
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001474
Orphan claim re-pointed
Claims processor
CLM-407418 → UHC-15937-04 (Rachel Munoz)
Member id
UHC-15937-04
Confidence
1
Method
probabilistic
MBR-009939CLM-407418
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001475
Orphan claim re-pointed
Claims processor
CLM-412200 → UHC-60598-92 (Karen Jackson)
Member id
UHC-60598-92
Confidence
0.97
Method
deterministic
MBR-008435CLM-412200
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001476
Orphan claim re-pointed
Claims processor
CLM-417592 → UHC-95805-53 (Dylan Meyer)
Member id
UHC-95805-53
Confidence
1
Method
probabilistic
MBR-002221CLM-417592
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001477
Orphan claim re-pointed
Claims processor
CLM-408187 → UHC-93294-76 (Abby Woods)
Member id
UHC-93294-76
Confidence
0.97
Method
deterministic
MBR-041648CLM-408187
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001478
Orphan claim re-pointed
Claims processor
CLM-420702 → UHC-72049-97 (Lauren Gutierrez)
Member id
UHC-72049-97
Confidence
1
Method
probabilistic
MBR-031367CLM-420702
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001479
Orphan claim re-pointed
Claims processor
CLM-432670 → UHC-92058-49 (Teresa Howell)
Member id
UHC-92058-49
Confidence
1
Method
probabilistic
MBR-001682CLM-432670
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001480
Orphan claim re-pointed
Claims processor
CLM-410236 → UHC-88130-96 (Sarah Wright)
Member id
UHC-88130-96
Confidence
1
Method
probabilistic
MBR-016114CLM-410236
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001481
Orphan claim re-pointed
Claims processor
CLM-409280 → UHC-62154-95 (Gloria Dominguez)
Member id
UHC-62154-95
Confidence
1
Method
probabilistic
MBR-020099CLM-409280
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001482
Orphan claim re-pointed
Claims processor
CLM-404652 → UHC-77455-70 (Hannah Wood)
Member id
UHC-77455-70
Confidence
1
Method
probabilistic
MBR-001591CLM-404652
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001483
Orphan claim re-pointed
Claims processor
CLM-431867 → UHC-08149-84 (Ronald Meyer)
Member id
UHC-08149-84
Confidence
1
Method
probabilistic
MBR-011997CLM-431867
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001484
Orphan claim re-pointed
Claims processor
CLM-407118 → UHC-83991-66 (Gloria Allen)
Member id
UHC-83991-66
Confidence
1
Method
probabilistic
MBR-030344CLM-407118
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001485
Orphan claim re-pointed
Claims processor
CLM-409798 → UHC-10790-41 (Justin Vargas)
Member id
UHC-10790-41
Confidence
1
Method
probabilistic
MBR-012439CLM-409798
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001486
Orphan claim re-pointed
Claims processor
CLM-414709 → UHC-31793-33 (Tyler Jones)
Member id
UHC-31793-33
Confidence
1
Method
probabilistic
MBR-022204CLM-414709
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001487
Orphan claim re-pointed
Claims processor
CLM-428731 → UHC-63032-05 (Julie Henry)
Member id
UHC-63032-05
Confidence
1
Method
probabilistic
MBR-023341CLM-428731
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001488
Orphan claim re-pointed
Claims processor
CLM-401993 → UHC-64409-56 (Alexis Henderson)
Member id
UHC-64409-56
Confidence
0.97
Method
deterministic
MBR-020588CLM-401993
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001489
Orphan claim re-pointed
Claims processor
CLM-404568 → UHC-79224-34 (Lisa Thompson)
Member id
UHC-79224-34
Confidence
1
Method
probabilistic
MBR-011203CLM-404568
Executed
resolution_agent
2026-10-19 19:54:39
14,086 rows, page 3 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.