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-008512
Orphan claim re-pointed
Claims processor
CLM-402713 → UHC-98906-09 (Kayla Gardner)
Member id
UHC-98906-09
Confidence
1
Method
probabilistic
MBR-036775CLM-402713
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008513
Orphan claim re-pointed
Claims processor
CLM-413348 → UHC-94353-46 (Frances Carpenter)
Member id
UHC-94353-46
Confidence
1
Method
probabilistic
MBR-000097CLM-413348
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008514
Orphan claim re-pointed
Claims processor
CLM-430674 → UHC-80993-98 (Wayne Reed)
Member id
UHC-80993-98
Confidence
0.97
Method
deterministic
MBR-015546CLM-430674
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008515
Orphan claim re-pointed
Claims processor
CLM-416756 → UHC-45364-76 (Christopher Thompson)
Member id
UHC-45364-76
Confidence
0.98
Method
probabilistic
MBR-022735CLM-416756
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008516
Orphan claim re-pointed
Claims processor
CLM-400944 → UHC-76429-95 (Amber Walker)
Member id
UHC-76429-95
Confidence
1
Method
probabilistic
MBR-038473CLM-400944
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008517
Orphan claim re-pointed
Claims processor
CLM-401771 → UHC-80576-44 (Gabriel Walker)
Member id
UHC-80576-44
Confidence
1
Method
probabilistic
MBR-040164CLM-401771
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008518
Orphan claim re-pointed
Claims processor
CLM-416770 → UHC-58307-57 (Samuel Montgomery)
Member id
UHC-58307-57
Confidence
1
Method
probabilistic
MBR-009055CLM-416770
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008519
Orphan claim re-pointed
Claims processor
CLM-431777 → UHC-30062-36 (Peter Elliott)
Member id
UHC-30062-36
Confidence
0.97
Method
deterministic
MBR-016776CLM-431777
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008520
Orphan claim re-pointed
Claims processor
CLM-426042 → UHC-76267-15 (Sara Willis)
Member id
UHC-76267-15
Confidence
1
Method
probabilistic
MBR-010981CLM-426042
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008521
Orphan claim re-pointed
Claims processor
CLM-400321 → UHC-81351-96 (Edward Wilson)
Member id
UHC-81351-96
Confidence
1
Method
probabilistic
MBR-019938CLM-400321
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008522
Orphan claim re-pointed
Claims processor
CLM-425610 → UHC-84542-04 (Nicole Evans)
Member id
UHC-84542-04
Confidence
1
Method
probabilistic
MBR-033414CLM-425610
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008523
Orphan claim re-pointed
Claims processor
CLM-410351 → UHC-71413-86 (Sophia Riley)
Member id
UHC-71413-86
Confidence
1
Method
probabilistic
MBR-001208CLM-410351
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008524
Orphan claim re-pointed
Claims processor
CLM-404020 → UHC-98500-33 (Ethan Rios)
Member id
UHC-98500-33
Confidence
1
Method
probabilistic
MBR-004731CLM-404020
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008525
Orphan claim re-pointed
Claims processor
CLM-414847 → UHC-75410-20 (Pamela Hughes)
Member id
UHC-75410-20
Confidence
1
Method
probabilistic
MBR-012222CLM-414847
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008526
Orphan claim re-pointed
Claims processor
CLM-410017 → UHC-41714-20 (Debra Rojas)
Member id
UHC-41714-20
Confidence
1
Method
probabilistic
MBR-004270CLM-410017
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008527
Orphan claim re-pointed
Claims processor
CLM-410380 → UHC-95165-36 (Sarah Cole)
Member id
UHC-95165-36
Confidence
0.97
Method
deterministic
MBR-002565CLM-410380
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008528
Orphan claim re-pointed
Claims processor
CLM-405374 → UHC-20937-43 (Sara Ray)
Member id
UHC-20937-43
Confidence
0.93
Method
probabilistic
MBR-025596CLM-405374
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008529
Orphan claim re-pointed
Claims processor
CLM-411970 → UHC-78209-60 (Nicole Vasquez)
Member id
UHC-78209-60
Confidence
0.99
Method
probabilistic
MBR-011681CLM-411970
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008530
Orphan claim re-pointed
Claims processor
CLM-422621 → UHC-50635-73 (Danielle Lee)
Member id
UHC-50635-73
Confidence
1
Method
probabilistic
MBR-028626CLM-422621
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008531
Orphan claim re-pointed
Claims processor
CLM-406066 → UHC-18059-43 (Joseph Henderson)
Member id
UHC-18059-43
Confidence
0.97
Method
deterministic
MBR-027796CLM-406066
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008532
Orphan claim re-pointed
Claims processor
CLM-413879 → UHC-97992-74 (Eugene Evans)
Member id
UHC-97992-74
Confidence
1
Method
probabilistic
MBR-000727CLM-413879
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008533
Orphan claim re-pointed
Claims processor
CLM-424820 → UHC-19767-52 (Maria Meyer)
Member id
UHC-19767-52
Confidence
1
Method
probabilistic
MBR-007812CLM-424820
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008534
Orphan claim re-pointed
Claims processor
CLM-418849 → UHC-34859-38 (Jeremy Harvey)
Member id
UHC-34859-38
Confidence
1
Method
probabilistic
MBR-033031CLM-418849
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008535
Orphan claim re-pointed
Claims processor
CLM-411869 → UHC-34364-53 (Judy Gibson)
Member id
UHC-34364-53
Confidence
1
Method
probabilistic
MBR-001535CLM-411869
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008536
Orphan claim re-pointed
Claims processor
CLM-423011 → UHC-36162-50 (Jenifer Edwards)
Member id
UHC-36162-50
Confidence
1.00
Method
probabilistic
MBR-045601CLM-423011
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008537
Orphan claim re-pointed
Claims processor
CLM-427905 → UHC-64401-23 (Adam Carlson)
Member id
UHC-64401-23
Confidence
1
Method
probabilistic
MBR-023780CLM-427905
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008538
Orphan claim re-pointed
Claims processor
CLM-409777 → UHC-73523-67 (Abigail Jenkins)
Member id
UHC-73523-67
Confidence
1
Method
probabilistic
MBR-027351CLM-409777
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008539
Orphan claim re-pointed
Claims processor
CLM-430617 → UHC-52155-31 (Helen Ryan)
Member id
UHC-52155-31
Confidence
0.98
Method
probabilistic
MBR-001526CLM-430617
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008540
Orphan claim re-pointed
Claims processor
CLM-411832 → UHC-39496-64 (Debra Cook)
Member id
UHC-39496-64
Confidence
1
Method
probabilistic
MBR-012737CLM-411832
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008541
Orphan claim re-pointed
Claims processor
CLM-430060 → UHC-16503-25 (Russell Gordon)
Member id
UHC-16503-25
Confidence
1
Method
probabilistic
MBR-002212CLM-430060
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008542
Orphan claim re-pointed
Claims processor
CLM-425301 → UHC-98479-41 (Theresa Rios)
Member id
UHC-98479-41
Confidence
1
Method
probabilistic
MBR-009000CLM-425301
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008543
Orphan claim re-pointed
Claims processor
CLM-419173 → UHC-24432-65 (Russell Cunningham)
Member id
UHC-24432-65
Confidence
0.97
Method
deterministic
MBR-024038CLM-419173
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008544
Orphan claim re-pointed
Claims processor
CLM-408918 → UHC-45527-99 (Wei Alexander)
Member id
UHC-45527-99
Confidence
0.97
Method
deterministic
MBR-023515CLM-408918
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008545
Orphan claim re-pointed
Claims processor
CLM-432654 → UHC-21594-17 (Stephen Watkins)
Member id
UHC-21594-17
Confidence
0.97
Method
deterministic
MBR-016003CLM-432654
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008546
Orphan claim re-pointed
Claims processor
CLM-404458 → UHC-48249-92 (Kelly Baker)
Member id
UHC-48249-92
Confidence
1
Method
probabilistic
MBR-000761CLM-404458
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008547
Orphan claim re-pointed
Claims processor
CLM-412835 → UHC-48987-35 (William Black)
Member id
UHC-48987-35
Confidence
1
Method
probabilistic
MBR-012887CLM-412835
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008548
Orphan claim re-pointed
Claims processor
CLM-417258 → UHC-61047-79 (Carolyn Gutierrez)
Member id
UHC-61047-79
Confidence
0.99
Method
probabilistic
MBR-040429CLM-417258
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008549
Orphan claim re-pointed
Claims processor
CLM-411975 → UHC-37749-59 (Anna Medina)
Member id
UHC-37749-59
Confidence
0.97
Method
deterministic
MBR-017072CLM-411975
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008550
Orphan claim re-pointed
Claims processor
CLM-409642 → UHC-10049-27 (Gerald Nichols)
Member id
UHC-10049-27
Confidence
1
Method
probabilistic
MBR-010210CLM-409642
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008551
Orphan claim re-pointed
Claims processor
CLM-415735 → UHC-78951-31 (Brian Wells)
Member id
UHC-78951-31
Confidence
1
Method
probabilistic
MBR-022470CLM-415735
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008552
Orphan claim re-pointed
Claims processor
CLM-412027 → UHC-77132-48 (Margaret Harris)
Member id
UHC-77132-48
Confidence
1
Method
probabilistic
MBR-025335CLM-412027
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008553
Orphan claim re-pointed
Claims processor
CLM-422162 → UHC-48834-19 (Amber Coleman)
Member id
UHC-48834-19
Confidence
1
Method
probabilistic
MBR-006900CLM-422162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008554
Orphan claim re-pointed
Claims processor
CLM-400642 → UHC-79256-52 (Yuki Berry)
Member id
UHC-79256-52
Confidence
0.85
Method
probabilistic
MBR-022534CLM-400642
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008555
Orphan claim re-pointed
Claims processor
CLM-415056 → UHC-89856-22 (Raymond Kim)
Member id
UHC-89856-22
Confidence
1
Method
probabilistic
MBR-010006CLM-415056
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008556
Orphan claim re-pointed
Claims processor
CLM-417421 → UHC-72089-26 (Juan Chen)
Member id
UHC-72089-26
Confidence
1
Method
probabilistic
MBR-000735CLM-417421
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008557
Orphan claim re-pointed
Claims processor
CLM-415533 → UHC-68186-75 (Jerry Dunn)
Member id
UHC-68186-75
Confidence
1
Method
probabilistic
MBR-017668CLM-415533
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008558
Orphan claim re-pointed
Claims processor
CLM-425336 → UHC-08701-85 (Larry Li)
Member id
UHC-08701-85
Confidence
0.97
Method
deterministic
MBR-014272CLM-425336
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008559
Orphan claim re-pointed
Claims processor
CLM-420916 → UHC-66768-58 (Janice Sandoval)
Member id
UHC-66768-58
Confidence
1
Method
probabilistic
MBR-014644CLM-420916
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008560
Orphan claim re-pointed
Claims processor
CLM-400003 → UHC-71667-70 (Christina Payne)
Member id
UHC-71667-70
Confidence
1
Method
probabilistic
MBR-029356CLM-400003
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008561
Orphan claim re-pointed
Claims processor
CLM-418972 → UHC-90592-70 (Logan Luna)
Member id
UHC-90592-70
Confidence
1
Method
probabilistic
MBR-002730CLM-418972
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 309 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.