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-009612
Orphan claim re-pointed
Claims processor
CLM-401629 → UHC-19610-84 (Jimmy Guzman)
Member id
UHC-19610-84
Confidence
1
Method
probabilistic
MBR-041617CLM-401629
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009613
Orphan claim re-pointed
Claims processor
CLM-416748 → UHC-01311-77 (Lauren Riley)
Member id
UHC-01311-77
Confidence
1
Method
probabilistic
MBR-023603CLM-416748
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009614
Orphan claim re-pointed
Claims processor
CLM-425867 → UHC-28110-84 (Roger Gordon)
Member id
UHC-28110-84
Confidence
1
Method
probabilistic
MBR-011208CLM-425867
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009615
Orphan claim re-pointed
Claims processor
CLM-432421 → UHC-69967-07 (Kayla Roberts)
Member id
UHC-69967-07
Confidence
0.97
Method
deterministic
MBR-012360CLM-432421
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009616
Orphan claim re-pointed
Claims processor
CLM-403073 → UHC-45695-22 (Diego West)
Member id
UHC-45695-22
Confidence
1
Method
probabilistic
MBR-000138CLM-403073
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009617
Orphan claim re-pointed
Claims processor
CLM-400972 → UHC-17854-92 (Beverly Gonzales)
Member id
UHC-17854-92
Confidence
0.97
Method
deterministic
MBR-020743CLM-400972
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009618
Orphan claim re-pointed
Claims processor
CLM-420085 → UHC-40806-34 (Betty Vega)
Member id
UHC-40806-34
Confidence
1
Method
probabilistic
MBR-007544CLM-420085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009619
Orphan claim re-pointed
Claims processor
CLM-401245 → UHC-50329-53 (Aisha Holmes)
Member id
UHC-50329-53
Confidence
0.97
Method
deterministic
MBR-028881CLM-401245
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009620
Orphan claim re-pointed
Claims processor
CLM-426319 → UHC-79699-27 (Abigail Price)
Member id
UHC-79699-27
Confidence
1
Method
probabilistic
MBR-001624CLM-426319
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009621
Orphan claim re-pointed
Claims processor
CLM-431808 → UHC-50109-81 (Beverly Warren)
Member id
UHC-50109-81
Confidence
1
Method
probabilistic
MBR-012231CLM-431808
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009622
Orphan claim re-pointed
Claims processor
CLM-407923 → UHC-95936-49 (Donald Aguilar)
Member id
UHC-95936-49
Confidence
1
Method
probabilistic
MBR-008842CLM-407923
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009623
Orphan claim re-pointed
Claims processor
CLM-419461 → UHC-48943-31 (Robert Myers)
Member id
UHC-48943-31
Confidence
0.97
Method
deterministic
MBR-008736CLM-419461
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009624
Orphan claim re-pointed
Claims processor
CLM-409278 → UHC-91114-24 (Jason Franklin)
Member id
UHC-91114-24
Confidence
1
Method
probabilistic
MBR-029075CLM-409278
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009625
Orphan claim re-pointed
Claims processor
CLM-431636 → UHC-70015-67 (Douglas Cruz)
Member id
UHC-70015-67
Confidence
1
Method
probabilistic
MBR-024344CLM-431636
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009626
Orphan claim re-pointed
Claims processor
CLM-428812 → UHC-19577-66 (Ralph Tran)
Member id
UHC-19577-66
Confidence
0.97
Method
deterministic
MBR-002126CLM-428812
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009627
Orphan claim re-pointed
Claims processor
CLM-410303 → UHC-33289-65 (Edward Cole)
Member id
UHC-33289-65
Confidence
0.99
Method
probabilistic
MBR-016288CLM-410303
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009628
Orphan claim re-pointed
Claims processor
CLM-418440 → UHC-44478-63 (Megan Ford)
Member id
UHC-44478-63
Confidence
1
Method
probabilistic
MBR-007367CLM-418440
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009629
Orphan claim re-pointed
Claims processor
CLM-406712 → UHC-65449-18 (Jessica Johnson)
Member id
UHC-65449-18
Confidence
0.94
Method
probabilistic
MBR-008134CLM-406712
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009630
Orphan claim re-pointed
Claims processor
CLM-430157 → UHC-68634-52 (David Marshall)
Member id
UHC-68634-52
Confidence
1
Method
probabilistic
MBR-017095CLM-430157
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009631
Orphan claim re-pointed
Claims processor
CLM-413362 → UHC-30684-46 (Ashley Griffin)
Member id
UHC-30684-46
Confidence
1
Method
probabilistic
MBR-042834CLM-413362
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009632
Orphan claim re-pointed
Claims processor
CLM-422608 → UHC-20775-72 (Jacqueline Flores)
Member id
UHC-20775-72
Confidence
1
Method
probabilistic
MBR-001217CLM-422608
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009633
Orphan claim re-pointed
Claims processor
CLM-417069 → UHC-73875-97 (Sara Wagner)
Member id
UHC-73875-97
Confidence
1
Method
probabilistic
MBR-021052CLM-417069
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009634
Orphan claim re-pointed
Claims processor
CLM-420327 → UHC-47052-61 (Kyle Smith)
Member id
UHC-47052-61
Confidence
1
Method
probabilistic
MBR-015444CLM-420327
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009635
Orphan claim re-pointed
Claims processor
CLM-418109 → UHC-29550-43 (Mason Murphy)
Member id
UHC-29550-43
Confidence
0.99
Method
probabilistic
MBR-032514CLM-418109
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009636
Orphan claim re-pointed
Claims processor
CLM-428770 → UHC-59697-99 (Sandra Bradley)
Member id
UHC-59697-99
Confidence
1
Method
probabilistic
MBR-026995CLM-428770
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009637
Orphan claim re-pointed
Claims processor
CLM-420765 → UHC-28186-60 (Joyce Carter)
Member id
UHC-28186-60
Confidence
0.97
Method
deterministic
MBR-002258CLM-420765
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009638
Orphan claim re-pointed
Claims processor
CLM-429102 → UHC-75690-49 (Brenda Phillips)
Member id
UHC-75690-49
Confidence
0.94
Method
probabilistic
MBR-021781CLM-429102
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009639
Orphan claim re-pointed
Claims processor
CLM-430052 → UHC-99220-13 (Julia Coleman)
Member id
UHC-99220-13
Confidence
1
Method
probabilistic
MBR-009110CLM-430052
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009640
Orphan claim re-pointed
Claims processor
CLM-402903 → UHC-84406-53 (Alexander Contreras)
Member id
UHC-84406-53
Confidence
1
Method
probabilistic
MBR-002419CLM-402903
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009641
Orphan claim re-pointed
Claims processor
CLM-427056 → UHC-73279-07 (Santiago Collins)
Member id
UHC-73279-07
Confidence
0.97
Method
deterministic
MBR-032146CLM-427056
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009642
Orphan claim re-pointed
Claims processor
CLM-406250 → UHC-02773-73 (Martha Rodriguez)
Member id
UHC-02773-73
Confidence
0.97
Method
deterministic
MBR-000708CLM-406250
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009643
Orphan claim re-pointed
Claims processor
CLM-405350 → UHC-50320-21 (Ana Bailey)
Member id
UHC-50320-21
Confidence
0.97
Method
deterministic
MBR-014435CLM-405350
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009644
Orphan claim re-pointed
Claims processor
CLM-425888 → UHC-90277-38 (Randy Edwards)
Member id
UHC-90277-38
Confidence
1
Method
probabilistic
MBR-013522CLM-425888
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009645
Orphan claim re-pointed
Claims processor
CLM-417736 → UHC-05335-91 (Wayne Castro)
Member id
UHC-05335-91
Confidence
0.97
Method
deterministic
MBR-009948CLM-417736
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009646
Orphan claim re-pointed
Claims processor
CLM-427729 → UHC-06478-92 (Alexander Smith)
Member id
UHC-06478-92
Confidence
0.99
Method
probabilistic
MBR-024489CLM-427729
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009647
Orphan claim re-pointed
Claims processor
CLM-418747 → UHC-00279-10 (Brittany Lucas)
Member id
UHC-00279-10
Confidence
0.98
Method
probabilistic
MBR-017816CLM-418747
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009648
Orphan claim re-pointed
Claims processor
CLM-406437 → UHC-33550-60 (Wei Nelson)
Member id
UHC-33550-60
Confidence
1
Method
probabilistic
MBR-020362CLM-406437
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009649
Orphan claim re-pointed
Claims processor
CLM-406880 → UHC-12515-95 (Ana Gibson)
Member id
UHC-12515-95
Confidence
1
Method
probabilistic
MBR-009099CLM-406880
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009650
Orphan claim re-pointed
Claims processor
CLM-417082 → UHC-29227-75 (Carolyn Sanchez)
Member id
UHC-29227-75
Confidence
1
Method
probabilistic
MBR-007385CLM-417082
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009651
Orphan claim re-pointed
Claims processor
CLM-407467 → UHC-13189-31 (Vincent Adams)
Member id
UHC-13189-31
Confidence
1
Method
probabilistic
MBR-035000CLM-407467
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009652
Orphan claim re-pointed
Claims processor
CLM-428481 → UHC-75505-45 (Keith Graham)
Member id
UHC-75505-45
Confidence
0.97
Method
deterministic
MBR-004957CLM-428481
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009653
Orphan claim re-pointed
Claims processor
CLM-422330 → UHC-52550-77 (Charles Cook)
Member id
UHC-52550-77
Confidence
0.97
Method
deterministic
MBR-015086CLM-422330
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009654
Orphan claim re-pointed
Claims processor
CLM-406382 → UHC-91130-49 (Vincent Jenkins)
Member id
UHC-91130-49
Confidence
1
Method
probabilistic
MBR-028379CLM-406382
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009655
Orphan claim re-pointed
Claims processor
CLM-403085 → UHC-61741-31 (Charlotte Rogers)
Member id
UHC-61741-31
Confidence
1
Method
probabilistic
MBR-015116CLM-403085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009656
Orphan claim re-pointed
Claims processor
CLM-420523 → UHC-80996-85 (Denise Ramos)
Member id
UHC-80996-85
Confidence
1
Method
probabilistic
MBR-003840CLM-420523
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009657
Orphan claim re-pointed
Claims processor
CLM-420771 → UHC-57626-40 (Jonathan Marquez)
Member id
UHC-57626-40
Confidence
0.97
Method
deterministic
MBR-043712CLM-420771
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009658
Orphan claim re-pointed
Claims processor
CLM-405783 → UHC-59682-46 (Doris Robertson)
Member id
UHC-59682-46
Confidence
1
Method
probabilistic
MBR-006165CLM-405783
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009659
Orphan claim re-pointed
Claims processor
CLM-431960 → UHC-03242-36 (Ralph Andrews)
Member id
UHC-03242-36
Confidence
1
Method
probabilistic
MBR-007960CLM-431960
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009660
Orphan claim re-pointed
Claims processor
CLM-428694 → UHC-92720-51 (Lucia Rios)
Member id
UHC-92720-51
Confidence
1
Method
probabilistic
MBR-006680CLM-428694
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009661
Orphan claim re-pointed
Claims processor
CLM-429793 → UHC-26263-45 (Jeremy Moore)
Member id
UHC-26263-45
Confidence
1
Method
probabilistic
MBR-000239CLM-429793
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 331 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.