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-008162
Orphan claim re-pointed
Claims processor
CLM-417875 → UHC-13108-98 (Madison Stephens)
Member id
UHC-13108-98
Confidence
1
Method
probabilistic
MBR-026307CLM-417875
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008163
Orphan claim re-pointed
Claims processor
CLM-424744 → UHC-06546-55 (Christine Le)
Member id
UHC-06546-55
Confidence
1
Method
probabilistic
MBR-010077CLM-424744
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008164
Orphan claim re-pointed
Claims processor
CLM-420522 → UHC-34094-33 (Judith Ford)
Member id
UHC-34094-33
Confidence
1
Method
probabilistic
MBR-000431CLM-420522
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008165
Orphan claim re-pointed
Claims processor
CLM-413644 → UHC-71517-82 (Lauren Hill)
Member id
UHC-71517-82
Confidence
1
Method
probabilistic
MBR-006426CLM-413644
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008166
Orphan claim re-pointed
Claims processor
CLM-407633 → UHC-51627-22 (Gregory Wagner)
Member id
UHC-51627-22
Confidence
0.99
Method
probabilistic
MBR-022674CLM-407633
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008167
Orphan claim re-pointed
Claims processor
CLM-406519 → UHC-19783-34 (Linda Myers)
Member id
UHC-19783-34
Confidence
1
Method
probabilistic
MBR-029428CLM-406519
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008168
Orphan claim re-pointed
Claims processor
CLM-421708 → UHC-09615-90 (Lauren Montgomery)
Member id
UHC-09615-90
Confidence
1
Method
probabilistic
MBR-009141CLM-421708
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008169
Orphan claim re-pointed
Claims processor
CLM-402941 → UHC-20249-57 (Patrick McDonald)
Member id
UHC-20249-57
Confidence
0.99
Method
probabilistic
MBR-007979CLM-402941
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008170
Orphan claim re-pointed
Claims processor
CLM-420887 → UHC-40188-10 (Diana Burns)
Member id
UHC-40188-10
Confidence
1
Method
probabilistic
MBR-028179CLM-420887
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008171
Orphan claim re-pointed
Claims processor
CLM-416563 → UHC-50426-10 (Margaret Tucker)
Member id
UHC-50426-10
Confidence
1
Method
probabilistic
MBR-021517CLM-416563
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008172
Orphan claim re-pointed
Claims processor
CLM-414218 → UHC-20492-19 (Andrew Hicks)
Member id
UHC-20492-19
Confidence
0.99
Method
probabilistic
MBR-019842CLM-414218
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008173
Orphan claim re-pointed
Claims processor
CLM-411317 → UHC-59588-79 (Betty Rojas)
Member id
UHC-59588-79
Confidence
1
Method
probabilistic
MBR-010963CLM-411317
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008174
Orphan claim re-pointed
Claims processor
CLM-407737 → UHC-00389-04 (Betty Boyd)
Member id
UHC-00389-04
Confidence
1
Method
probabilistic
MBR-004129CLM-407737
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008175
Orphan claim re-pointed
Claims processor
CLM-405200 → UHC-39326-26 (Amy Reed)
Member id
UHC-39326-26
Confidence
1
Method
probabilistic
MBR-013035CLM-405200
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008176
Orphan claim re-pointed
Claims processor
CLM-426756 → UHC-51903-21 (Debra Andrews)
Member id
UHC-51903-21
Confidence
1
Method
probabilistic
MBR-034280CLM-426756
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008177
Orphan claim re-pointed
Claims processor
CLM-401347 → UHC-17441-60 (Rebecca Sims)
Member id
UHC-17441-60
Confidence
0.93
Method
probabilistic
MBR-006800CLM-401347
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008178
Orphan claim re-pointed
Claims processor
CLM-415407 → UHC-58083-73 (Jean Cruz)
Member id
UHC-58083-73
Confidence
1
Method
probabilistic
MBR-028817CLM-415407
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008179
Orphan claim re-pointed
Claims processor
CLM-432369 → UHC-01660-56 (Brandon Martin)
Member id
UHC-01660-56
Confidence
1
Method
probabilistic
MBR-012247CLM-432369
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008180
Orphan claim re-pointed
Claims processor
CLM-400497 → UHC-65932-60 (Judith Gonzales)
Member id
UHC-65932-60
Confidence
1
Method
probabilistic
MBR-011958CLM-400497
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008181
Orphan claim re-pointed
Claims processor
CLM-431881 → UHC-48820-35 (Gloria Lane)
Member id
UHC-48820-35
Confidence
0.97
Method
deterministic
MBR-008756CLM-431881
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008182
Orphan claim re-pointed
Claims processor
CLM-410840 → UHC-11699-14 (Amy Martin)
Member id
UHC-11699-14
Confidence
1
Method
probabilistic
MBR-018876CLM-410840
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008183
Orphan claim re-pointed
Claims processor
CLM-406443 → UHC-43328-08 (Abby Vazquez)
Member id
UHC-43328-08
Confidence
1
Method
probabilistic
MBR-011460CLM-406443
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008184
Orphan claim re-pointed
Claims processor
CLM-426050 → UHC-61080-99 (Sarah Carlson)
Member id
UHC-61080-99
Confidence
1
Method
probabilistic
MBR-025232CLM-426050
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008185
Orphan claim re-pointed
Claims processor
CLM-415758 → UHC-55567-38 (Michael Schultz)
Member id
UHC-55567-38
Confidence
0.97
Method
deterministic
MBR-000617CLM-415758
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008186
Orphan claim re-pointed
Claims processor
CLM-401987 → UHC-29928-29 (Stephen Garza)
Member id
UHC-29928-29
Confidence
1
Method
probabilistic
MBR-029823CLM-401987
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008187
Orphan claim re-pointed
Claims processor
CLM-420366 → UHC-82931-02 (Kayla Pena)
Member id
UHC-82931-02
Confidence
1
Method
probabilistic
MBR-020559CLM-420366
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008188
Orphan claim re-pointed
Claims processor
CLM-424174 → UHC-90955-10 (Doris Rice)
Member id
UHC-90955-10
Confidence
1
Method
probabilistic
MBR-036564CLM-424174
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008189
Orphan claim re-pointed
Claims processor
CLM-414138 → UHC-72994-01 (Raymond Banks)
Member id
UHC-72994-01
Confidence
1
Method
probabilistic
MBR-007745CLM-414138
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008190
Orphan claim re-pointed
Claims processor
CLM-418412 → UHC-64354-17 (Judy Soto)
Member id
UHC-64354-17
Confidence
1
Method
probabilistic
MBR-000209CLM-418412
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008191
Orphan claim re-pointed
Claims processor
CLM-414894 → UHC-01376-40 (Lisa Nunez)
Member id
UHC-01376-40
Confidence
1
Method
probabilistic
MBR-026484CLM-414894
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008192
Orphan claim re-pointed
Claims processor
CLM-405526 → UHC-00298-63 (Danielle Walsh)
Member id
UHC-00298-63
Confidence
1
Method
probabilistic
MBR-004008CLM-405526
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008193
Orphan claim re-pointed
Claims processor
CLM-421599 → UHC-89226-72 (Jacob Ramirez)
Member id
UHC-89226-72
Confidence
1
Method
probabilistic
MBR-020000CLM-421599
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008194
Orphan claim re-pointed
Claims processor
CLM-408677 → UHC-20074-87 (Janice Burton)
Member id
UHC-20074-87
Confidence
1
Method
probabilistic
MBR-029235CLM-408677
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008195
Orphan claim re-pointed
Claims processor
CLM-408975 → UHC-27676-63 (Nicole Sullivan)
Member id
UHC-27676-63
Confidence
0.97
Method
deterministic
MBR-029876CLM-408975
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008196
Orphan claim re-pointed
Claims processor
CLM-428529 → UHC-27116-73 (Maria Wagner)
Member id
UHC-27116-73
Confidence
0.97
Method
deterministic
MBR-001086CLM-428529
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008197
Orphan claim re-pointed
Claims processor
CLM-400759 → UHC-42668-04 (Kenneth Stewart)
Member id
UHC-42668-04
Confidence
1
Method
probabilistic
MBR-021203CLM-400759
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008198
Orphan claim re-pointed
Claims processor
CLM-401728 → UHC-85766-54 (Ethan Le)
Member id
UHC-85766-54
Confidence
1
Method
probabilistic
MBR-007125CLM-401728
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008199
Orphan claim re-pointed
Claims processor
CLM-429657 → UHC-11052-08 (Nancy Watkins)
Member id
UHC-11052-08
Confidence
1
Method
probabilistic
MBR-035796CLM-429657
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008200
Orphan claim re-pointed
Claims processor
CLM-408659 → UHC-69557-31 (Roger Morrison)
Member id
UHC-69557-31
Confidence
1
Method
probabilistic
MBR-003053CLM-408659
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008201
Orphan claim re-pointed
Claims processor
CLM-404554 → UHC-68737-10 (Julie Fields)
Member id
UHC-68737-10
Confidence
0.97
Method
deterministic
MBR-024360CLM-404554
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008202
Orphan claim re-pointed
Claims processor
CLM-429291 → UHC-01150-30 (Amanda Price)
Member id
UHC-01150-30
Confidence
1
Method
probabilistic
MBR-036995CLM-429291
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008203
Orphan claim re-pointed
Claims processor
CLM-410094 → UHC-56018-98 (Emily Nguyen)
Member id
UHC-56018-98
Confidence
1
Method
probabilistic
MBR-003371CLM-410094
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008204
Orphan claim re-pointed
Claims processor
CLM-427394 → UHC-06530-77 (Philip Wells)
Member id
UHC-06530-77
Confidence
1
Method
probabilistic
MBR-033746CLM-427394
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008205
Orphan claim re-pointed
Claims processor
CLM-404968 → UHC-50684-94 (Sam Miller)
Member id
UHC-50684-94
Confidence
1
Method
probabilistic
MBR-006240CLM-404968
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008206
Orphan claim re-pointed
Claims processor
CLM-420635 → UHC-37443-96 (Camila Hart)
Member id
UHC-37443-96
Confidence
1
Method
probabilistic
MBR-010163CLM-420635
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008207
Orphan claim re-pointed
Claims processor
CLM-406792 → UHC-89971-19 (Diana Estrada)
Member id
UHC-89971-19
Confidence
1
Method
probabilistic
MBR-027016CLM-406792
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008208
Orphan claim re-pointed
Claims processor
CLM-421369 → UHC-91386-44 (Jeffrey Baker)
Member id
UHC-91386-44
Confidence
1
Method
probabilistic
MBR-016413CLM-421369
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008209
Orphan claim re-pointed
Claims processor
CLM-416951 → UHC-99986-31 (Angela Delgado)
Member id
UHC-99986-31
Confidence
1
Method
probabilistic
MBR-029990CLM-416951
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008210
Orphan claim re-pointed
Claims processor
CLM-421527 → UHC-23118-53 (Mari Montgomery)
Member id
UHC-23118-53
Confidence
1
Method
probabilistic
MBR-012795CLM-421527
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008211
Orphan claim re-pointed
Claims processor
CLM-418397 → UHC-50522-01 (Frank Watkins)
Member id
UHC-50522-01
Confidence
1
Method
probabilistic
MBR-020657CLM-418397
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 302 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.