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-002940
Orphan claim re-pointed
Claims processor
CLM-411495 → UHC-15071-61 (Edward Ward)
Member id
UHC-15071-61
Confidence
0.99
Method
probabilistic
MBR-006040CLM-411495
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002941
Orphan claim re-pointed
Claims processor
CLM-427748 → UHC-55520-85 (Mark Valdez)
Member id
UHC-55520-85
Confidence
1
Method
probabilistic
MBR-011706CLM-427748
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002942
Orphan claim re-pointed
Claims processor
CLM-417547 → UHC-94639-58 (Cynthia Flores)
Member id
UHC-94639-58
Confidence
0.97
Method
deterministic
MBR-041462CLM-417547
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002943
Orphan claim re-pointed
Claims processor
CLM-417433 → UHC-20657-68 (Vicky Hamilton)
Member id
UHC-20657-68
Confidence
0.99
Method
probabilistic
MBR-002760CLM-417433
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002944
Orphan claim re-pointed
Claims processor
CLM-406210 → UHC-00624-02 (Kathryn Ramirez)
Member id
UHC-00624-02
Confidence
1
Method
probabilistic
MBR-025889CLM-406210
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002945
Orphan claim re-pointed
Claims processor
CLM-407950 → UHC-49719-35 (Juan Weaver)
Member id
UHC-49719-35
Confidence
1
Method
probabilistic
MBR-029456CLM-407950
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002946
Orphan claim re-pointed
Claims processor
CLM-407389 → UHC-64364-04 (Barb Schultz)
Member id
UHC-64364-04
Confidence
1
Method
probabilistic
MBR-006946CLM-407389
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002947
Orphan claim re-pointed
Claims processor
CLM-410179 → UHC-54232-44 (Brian Richardson)
Member id
UHC-54232-44
Confidence
1
Method
probabilistic
MBR-036933CLM-410179
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002948
Orphan claim re-pointed
Claims processor
CLM-411071 → UHC-35219-28 (Elizabeth Tucker)
Member id
UHC-35219-28
Confidence
0.97
Method
deterministic
MBR-029921CLM-411071
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002949
Orphan claim re-pointed
Claims processor
CLM-400832 → UHC-00120-23 (Hannah Burke)
Member id
UHC-00120-23
Confidence
1
Method
probabilistic
MBR-015128CLM-400832
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002950
Orphan claim re-pointed
Claims processor
CLM-426232 → UHC-68851-64 (Russell Holmes)
Member id
UHC-68851-64
Confidence
1
Method
probabilistic
MBR-012692CLM-426232
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002951
Orphan claim re-pointed
Claims processor
CLM-425972 → UHC-96613-08 (Natalie Johnston)
Member id
UHC-96613-08
Confidence
1
Method
probabilistic
MBR-015614CLM-425972
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002952
Orphan claim re-pointed
Claims processor
CLM-407714 → UHC-43246-58 (Amy Elliott)
Member id
UHC-43246-58
Confidence
1
Method
probabilistic
MBR-019067CLM-407714
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002953
Orphan claim re-pointed
Claims processor
CLM-416652 → UHC-53251-10 (Lori Gray)
Member id
UHC-53251-10
Confidence
0.97
Method
deterministic
MBR-028303CLM-416652
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002954
Orphan claim re-pointed
Claims processor
CLM-423809 → UHC-94219-79 (Natalie Crawford)
Member id
UHC-94219-79
Confidence
1
Method
probabilistic
MBR-023239CLM-423809
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002955
Orphan claim re-pointed
Claims processor
CLM-429302 → UHC-72399-15 (Kimberly Boyd)
Member id
UHC-72399-15
Confidence
1
Method
probabilistic
MBR-003776CLM-429302
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002956
Orphan claim re-pointed
Claims processor
CLM-408653 → UHC-87938-64 (Katherine Williamson)
Member id
UHC-87938-64
Confidence
1
Method
probabilistic
MBR-016128CLM-408653
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002957
Orphan claim re-pointed
Claims processor
CLM-402947 → UHC-97085-20 (Chistine Weaver)
Member id
UHC-97085-20
Confidence
0.97
Method
deterministic
MBR-014957CLM-402947
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002958
Orphan claim re-pointed
Claims processor
CLM-431015 → UHC-49258-37 (Chritsian Daniels)
Member id
UHC-49258-37
Confidence
1.00
Method
probabilistic
MBR-019293CLM-431015
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002959
Orphan claim re-pointed
Claims processor
CLM-423800 → UHC-40176-31 (Isabella Allen)
Member id
UHC-40176-31
Confidence
1
Method
probabilistic
MBR-022874CLM-423800
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002960
Orphan claim re-pointed
Claims processor
CLM-401290 → UHC-91005-74 (Nancy George)
Member id
UHC-91005-74
Confidence
0.99
Method
probabilistic
MBR-012862CLM-401290
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002961
Orphan claim re-pointed
Claims processor
CLM-404991 → UHC-58921-61 (Samuel Cruz)
Member id
UHC-58921-61
Confidence
0.96
Method
probabilistic
MBR-019509CLM-404991
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002962
Orphan claim re-pointed
Claims processor
CLM-412854 → UHC-22603-96 (Aisha McCoy)
Member id
UHC-22603-96
Confidence
0.97
Method
deterministic
MBR-024470CLM-412854
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002963
Orphan claim re-pointed
Claims processor
CLM-409422 → UHC-40678-60 (Jesse Hernandez)
Member id
UHC-40678-60
Confidence
1
Method
probabilistic
MBR-023867CLM-409422
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002964
Orphan claim re-pointed
Claims processor
CLM-412159 → UHC-00900-40 (Benjamin Rice)
Member id
UHC-00900-40
Confidence
0.94
Method
probabilistic
MBR-008390CLM-412159
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002965
Orphan claim re-pointed
Claims processor
CLM-415292 → UHC-21639-91 (Kathryn Contreras)
Member id
UHC-21639-91
Confidence
1
Method
probabilistic
MBR-008466CLM-415292
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002966
Orphan claim re-pointed
Claims processor
CLM-402890 → UHC-70840-06 (Grace Hawkins)
Member id
UHC-70840-06
Confidence
0.93
Method
probabilistic
MBR-016353CLM-402890
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002967
Orphan claim re-pointed
Claims processor
CLM-420792 → UHC-27291-77 (Diane Lewis)
Member id
UHC-27291-77
Confidence
1
Method
probabilistic
MBR-034970CLM-420792
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002968
Orphan claim re-pointed
Claims processor
CLM-423030 → UHC-06344-17 (Diana Bradley)
Member id
UHC-06344-17
Confidence
0.97
Method
deterministic
MBR-003450CLM-423030
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002969
Orphan claim re-pointed
Claims processor
CLM-410615 → UHC-86536-44 (Bobby Stephens)
Member id
UHC-86536-44
Confidence
1
Method
probabilistic
MBR-021500CLM-410615
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002970
Orphan claim re-pointed
Claims processor
CLM-426949 → UHC-06715-98 (Karen Powell)
Member id
UHC-06715-98
Confidence
1
Method
probabilistic
MBR-006911CLM-426949
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002971
Orphan claim re-pointed
Claims processor
CLM-429162 → UHC-10977-25 (Evelyn Grant)
Member id
UHC-10977-25
Confidence
0.99
Method
probabilistic
MBR-018177CLM-429162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002972
Orphan claim re-pointed
Claims processor
CLM-400421 → UHC-99110-39 (Sophia Evans)
Member id
UHC-99110-39
Confidence
0.97
Method
deterministic
MBR-042873CLM-400421
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002973
Orphan claim re-pointed
Claims processor
CLM-412542 → UHC-90874-75 (Debra Powell)
Member id
UHC-90874-75
Confidence
1
Method
probabilistic
MBR-019608CLM-412542
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002974
Orphan claim re-pointed
Claims processor
CLM-431032 → UHC-29407-99 (Lauren Snyder)
Member id
UHC-29407-99
Confidence
1
Method
probabilistic
MBR-018943CLM-431032
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002975
Orphan claim re-pointed
Claims processor
CLM-403533 → UHC-45932-54 (Mateo Kim)
Member id
UHC-45932-54
Confidence
1
Method
probabilistic
MBR-004779CLM-403533
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002976
Orphan claim re-pointed
Claims processor
CLM-414180 → UHC-51915-20 (Dorothy Boyd)
Member id
UHC-51915-20
Confidence
1
Method
probabilistic
MBR-026631CLM-414180
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002977
Orphan claim re-pointed
Claims processor
CLM-427759 → UHC-39408-66 (Raymond Black)
Member id
UHC-39408-66
Confidence
0.97
Method
deterministic
MBR-008823CLM-427759
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002978
Orphan claim re-pointed
Claims processor
CLM-415594 → UHC-51922-20 (Justin Alexander)
Member id
UHC-51922-20
Confidence
0.90
Method
probabilistic
MBR-028266CLM-415594
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002979
Orphan claim re-pointed
Claims processor
CLM-402901 → UHC-24458-91 (Sarah Green)
Member id
UHC-24458-91
Confidence
1
Method
probabilistic
MBR-003772CLM-402901
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002980
Orphan claim re-pointed
Claims processor
CLM-423654 → UHC-98958-75 (Jonathan Castillo)
Member id
UHC-98958-75
Confidence
1
Method
probabilistic
MBR-005391CLM-423654
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002981
Orphan claim re-pointed
Claims processor
CLM-411382 → UHC-22701-62 (Brandon Vazquez)
Member id
UHC-22701-62
Confidence
0.97
Method
deterministic
MBR-029477CLM-411382
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002982
Orphan claim re-pointed
Claims processor
CLM-409127 → UHC-97744-57 (Robert Pierce)
Member id
UHC-97744-57
Confidence
1
Method
probabilistic
MBR-004908CLM-409127
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002983
Orphan claim re-pointed
Claims processor
CLM-430295 → UHC-73490-52 (Helen Ellis)
Member id
UHC-73490-52
Confidence
0.97
Method
deterministic
MBR-016740CLM-430295
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002984
Orphan claim re-pointed
Claims processor
CLM-428308 → UHC-63351-43 (Jerry Perkins)
Member id
UHC-63351-43
Confidence
0.99
Method
probabilistic
MBR-007345CLM-428308
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002985
Orphan claim re-pointed
Claims processor
CLM-429796 → UHC-88610-44 (Sandra Hart)
Member id
UHC-88610-44
Confidence
1
Method
probabilistic
MBR-004045CLM-429796
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002986
Orphan claim re-pointed
Claims processor
CLM-403194 → UHC-89275-42 (Dennis Hunt)
Member id
UHC-89275-42
Confidence
1
Method
probabilistic
MBR-033966CLM-403194
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002987
Orphan claim re-pointed
Claims processor
CLM-420031 → UHC-84313-87 (Walter Vazquez)
Member id
UHC-84313-87
Confidence
1
Method
probabilistic
MBR-017241CLM-420031
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002988
Orphan claim re-pointed
Claims processor
CLM-417297 → UHC-16649-11 (Lawrence Chapman)
Member id
UHC-16649-11
Confidence
1
Method
probabilistic
MBR-016274CLM-417297
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002989
Orphan claim re-pointed
Claims processor
CLM-402210 → UHC-99178-38 (Alexis Shaw)
Member id
UHC-99178-38
Confidence
1
Method
probabilistic
MBR-015430CLM-402210
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 33 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.