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-009512
Orphan claim re-pointed
Claims processor
CLM-428552 → UHC-68273-18 (Eugene Mendez)
Member id
UHC-68273-18
Confidence
0.97
Method
deterministic
MBR-035819CLM-428552
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009513
Orphan claim re-pointed
Claims processor
CLM-417490 → UHC-67574-82 (Logan Rodriguez)
Member id
UHC-67574-82
Confidence
1
Method
probabilistic
MBR-033372CLM-417490
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009514
Orphan claim re-pointed
Claims processor
CLM-417246 → UHC-66093-90 (Kimberly Flores)
Member id
UHC-66093-90
Confidence
0.97
Method
deterministic
MBR-030208CLM-417246
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009515
Orphan claim re-pointed
Claims processor
CLM-423807 → UHC-53640-66 (Carlos Jensen)
Member id
UHC-53640-66
Confidence
1
Method
probabilistic
MBR-001374CLM-423807
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009516
Orphan claim re-pointed
Claims processor
CLM-427532 → UHC-81174-40 (Christian Meyer)
Member id
UHC-81174-40
Confidence
1
Method
probabilistic
MBR-008776CLM-427532
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009517
Orphan claim re-pointed
Claims processor
CLM-415992 → UHC-73997-97 (Charlotte Lopez)
Member id
UHC-73997-97
Confidence
1
Method
probabilistic
MBR-003020CLM-415992
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009518
Orphan claim re-pointed
Claims processor
CLM-400148 → UHC-45106-70 (Jennifer Cole)
Member id
UHC-45106-70
Confidence
1
Method
probabilistic
MBR-012290CLM-400148
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009519
Orphan claim re-pointed
Claims processor
CLM-423236 → UHC-40992-46 (Diana Perkins)
Member id
UHC-40992-46
Confidence
0.99
Method
probabilistic
MBR-011419CLM-423236
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009520
Orphan claim re-pointed
Claims processor
CLM-400676 → UHC-34291-20 (Raymond Mendoza)
Member id
UHC-34291-20
Confidence
1
Method
probabilistic
MBR-029525CLM-400676
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009521
Orphan claim re-pointed
Claims processor
CLM-410246 → UHC-81797-93 (Bradley Hall)
Member id
UHC-81797-93
Confidence
0.93
Method
probabilistic
MBR-007071CLM-410246
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009522
Orphan claim re-pointed
Claims processor
CLM-419977 → UHC-30205-67 (Peter Reyes)
Member id
UHC-30205-67
Confidence
1
Method
probabilistic
MBR-030941CLM-419977
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009523
Orphan claim re-pointed
Claims processor
CLM-421118 → UHC-33321-26 (Jessica Schmidt)
Member id
UHC-33321-26
Confidence
1
Method
probabilistic
MBR-008071CLM-421118
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009524
Orphan claim re-pointed
Claims processor
CLM-430322 → UHC-75817-92 (Amber McDonald)
Member id
UHC-75817-92
Confidence
1
Method
probabilistic
MBR-018319CLM-430322
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009525
Orphan claim re-pointed
Claims processor
CLM-408201 → UHC-55258-87 (Theresa Torres)
Member id
UHC-55258-87
Confidence
1
Method
probabilistic
MBR-002788CLM-408201
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009526
Orphan claim re-pointed
Claims processor
CLM-416562 → UHC-47259-09 (Priya Ellis)
Member id
UHC-47259-09
Confidence
0.97
Method
deterministic
MBR-017939CLM-416562
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009527
Orphan claim re-pointed
Claims processor
CLM-408987 → UHC-24111-97 (Betty Fields)
Member id
UHC-24111-97
Confidence
1
Method
probabilistic
MBR-026120CLM-408987
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009528
Orphan claim re-pointed
Claims processor
CLM-408683 → UHC-31244-35 (Douglas Boyd)
Member id
UHC-31244-35
Confidence
0.98
Method
probabilistic
MBR-001332CLM-408683
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009529
Orphan claim re-pointed
Claims processor
CLM-422855 → UHC-21650-45 (Timothy Butler)
Member id
UHC-21650-45
Confidence
1
Method
probabilistic
MBR-031550CLM-422855
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009530
Orphan claim re-pointed
Claims processor
CLM-403254 → UHC-29251-65 (Jean Contreras)
Member id
UHC-29251-65
Confidence
1
Method
probabilistic
MBR-036503CLM-403254
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009531
Orphan claim re-pointed
Claims processor
CLM-412623 → UHC-05005-65 (Vincent George)
Member id
UHC-05005-65
Confidence
1
Method
probabilistic
MBR-001280CLM-412623
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009532
Orphan claim re-pointed
Claims processor
CLM-414528 → UHC-91573-67 (Bryan Anderson)
Member id
UHC-91573-67
Confidence
0.93
Method
probabilistic
MBR-019573CLM-414528
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009533
Orphan claim re-pointed
Claims processor
CLM-410743 → UHC-41204-86 (Gregory Hudson)
Member id
UHC-41204-86
Confidence
1
Method
probabilistic
MBR-004926CLM-410743
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009534
Orphan claim re-pointed
Claims processor
CLM-405362 → UHC-59196-09 (Brandon Hansen)
Member id
UHC-59196-09
Confidence
0.99
Method
probabilistic
MBR-000868CLM-405362
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009535
Orphan claim re-pointed
Claims processor
CLM-423868 → UHC-91604-29 (Mariana Peterson)
Member id
UHC-91604-29
Confidence
1
Method
probabilistic
MBR-018242CLM-423868
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009536
Orphan claim re-pointed
Claims processor
CLM-418485 → UHC-51877-99 (Ruth Bell)
Member id
UHC-51877-99
Confidence
1
Method
probabilistic
MBR-024910CLM-418485
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009537
Orphan claim re-pointed
Claims processor
CLM-415005 → UHC-86062-54 (Laura Watkins)
Member id
UHC-86062-54
Confidence
1
Method
probabilistic
MBR-014514CLM-415005
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009538
Orphan claim re-pointed
Claims processor
CLM-400262 → UHC-61133-79 (Ronald Estrada)
Member id
UHC-61133-79
Confidence
1
Method
probabilistic
MBR-042087CLM-400262
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009539
Orphan claim re-pointed
Claims processor
CLM-420234 → UHC-25421-25 (Karen Ruiz)
Member id
UHC-25421-25
Confidence
1
Method
probabilistic
MBR-005611CLM-420234
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009540
Orphan claim re-pointed
Claims processor
CLM-426058 → UHC-29564-55 (Carol Arnold)
Member id
UHC-29564-55
Confidence
1
Method
probabilistic
MBR-006224CLM-426058
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009541
Orphan claim re-pointed
Claims processor
CLM-411152 → UHC-10284-69 (Megan Burke)
Member id
UHC-10284-69
Confidence
0.97
Method
deterministic
MBR-033441CLM-411152
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009542
Orphan claim re-pointed
Claims processor
CLM-428800 → UHC-17958-15 (Hiroshi Shaw)
Member id
UHC-17958-15
Confidence
0.97
Method
deterministic
MBR-015681CLM-428800
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009543
Orphan claim re-pointed
Claims processor
CLM-423978 → UHC-23564-09 (Kimberly Dominguez)
Member id
UHC-23564-09
Confidence
1
Method
probabilistic
MBR-004737CLM-423978
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009544
Orphan claim re-pointed
Claims processor
CLM-428327 → UHC-92262-47 (Valentina Greene)
Member id
UHC-92262-47
Confidence
1
Method
probabilistic
MBR-037961CLM-428327
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009545
Orphan claim re-pointed
Claims processor
CLM-420156 → UHC-63388-86 (Theresa Tucker)
Member id
UHC-63388-86
Confidence
0.94
Method
probabilistic
MBR-019489CLM-420156
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009546
Orphan claim re-pointed
Claims processor
CLM-419530 → UHC-16662-97 (Ashley Munoz)
Member id
UHC-16662-97
Confidence
1
Method
probabilistic
MBR-006139CLM-419530
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009547
Orphan claim re-pointed
Claims processor
CLM-403332 → UHC-81477-97 (Teresa Hayes)
Member id
UHC-81477-97
Confidence
1
Method
probabilistic
MBR-012681CLM-403332
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009548
Orphan claim re-pointed
Claims processor
CLM-411655 → UHC-19399-24 (Ann Williamson)
Member id
UHC-19399-24
Confidence
1
Method
probabilistic
MBR-005080CLM-411655
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009549
Orphan claim re-pointed
Claims processor
CLM-409473 → UHC-58278-39 (Douglas Robinson)
Member id
UHC-58278-39
Confidence
1
Method
probabilistic
MBR-020061CLM-409473
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009550
Orphan claim re-pointed
Claims processor
CLM-410056 → UHC-99251-17 (Randy Mason)
Member id
UHC-99251-17
Confidence
0.97
Method
deterministic
MBR-030737CLM-410056
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009551
Orphan claim re-pointed
Claims processor
CLM-404594 → UHC-13136-66 (Amber Mejia)
Member id
UHC-13136-66
Confidence
1
Method
probabilistic
MBR-017053CLM-404594
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009552
Orphan claim re-pointed
Claims processor
CLM-423159 → UHC-31409-02 (Ryan Soto)
Member id
UHC-31409-02
Confidence
1
Method
probabilistic
MBR-025104CLM-423159
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009553
Orphan claim re-pointed
Claims processor
CLM-414540 → UHC-56827-60 (Bobby Carroll)
Member id
UHC-56827-60
Confidence
0.97
Method
deterministic
MBR-024104CLM-414540
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009554
Orphan claim re-pointed
Claims processor
CLM-408276 → UHC-42995-06 (Debra Fuller)
Member id
UHC-42995-06
Confidence
1
Method
probabilistic
MBR-025528CLM-408276
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009555
Orphan claim re-pointed
Claims processor
CLM-423794 → UHC-39955-17 (Samantha Reid)
Member id
UHC-39955-17
Confidence
1
Method
probabilistic
MBR-005939CLM-423794
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009556
Orphan claim re-pointed
Claims processor
CLM-425927 → UHC-21896-71 (Benjamin Brown)
Member id
UHC-21896-71
Confidence
0.97
Method
deterministic
MBR-013190CLM-425927
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009557
Orphan claim re-pointed
Claims processor
CLM-418598 → UHC-26249-22 (Henry Daniels)
Member id
UHC-26249-22
Confidence
0.99
Method
probabilistic
MBR-016105CLM-418598
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009558
Orphan claim re-pointed
Claims processor
CLM-417709 → UHC-65636-63 (Noah James)
Member id
UHC-65636-63
Confidence
1
Method
probabilistic
MBR-030355CLM-417709
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009559
Orphan claim re-pointed
Claims processor
CLM-400162 → UHC-59351-27 (Cynthia Peterson)
Member id
UHC-59351-27
Confidence
1
Method
probabilistic
MBR-032047CLM-400162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009560
Orphan claim re-pointed
Claims processor
CLM-416666 → UHC-82604-10 (Andrea Lawson)
Member id
UHC-82604-10
Confidence
1
Method
probabilistic
MBR-007026CLM-416666
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009561
Orphan claim re-pointed
Claims processor
CLM-412565 → UHC-31114-80 (Kathleen Lane)
Member id
UHC-31114-80
Confidence
1
Method
probabilistic
MBR-008165CLM-412565
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 329 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.