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-003140
Orphan claim re-pointed
Claims processor
CLM-429419 → UHC-97480-71 (Billy Herrera)
Member id
UHC-97480-71
Confidence
0.92
Method
probabilistic
MBR-017927CLM-429419
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003141
Orphan claim re-pointed
Claims processor
CLM-414629 → UHC-86083-39 (Kathryn Gray)
Member id
UHC-86083-39
Confidence
0.97
Method
deterministic
MBR-011032CLM-414629
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003142
Orphan claim re-pointed
Claims processor
CLM-419130 → UHC-77185-29 (Albert Freeman)
Member id
UHC-77185-29
Confidence
0.97
Method
deterministic
MBR-043622CLM-419130
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003143
Orphan claim re-pointed
Claims processor
CLM-408793 → UHC-55422-71 (Nancy Simpson)
Member id
UHC-55422-71
Confidence
1
Method
probabilistic
MBR-005298CLM-408793
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003144
Orphan claim re-pointed
Claims processor
CLM-431847 → UHC-07344-39 (Roy James)
Member id
UHC-07344-39
Confidence
1
Method
probabilistic
MBR-007895CLM-431847
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003145
Orphan claim re-pointed
Claims processor
CLM-408498 → UHC-35056-20 (Alexander Carter)
Member id
UHC-35056-20
Confidence
0.97
Method
deterministic
MBR-012069CLM-408498
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003146
Orphan claim re-pointed
Claims processor
CLM-420418 → UHC-88855-86 (Samantha Hawkins)
Member id
UHC-88855-86
Confidence
1
Method
probabilistic
MBR-010581CLM-420418
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003147
Orphan claim re-pointed
Claims processor
CLM-423396 → UHC-08669-16 (Vicky Cook)
Member id
UHC-08669-16
Confidence
1
Method
probabilistic
MBR-011740CLM-423396
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003148
Orphan claim re-pointed
Claims processor
CLM-423933 → UHC-78913-28 (Sara Wallace)
Member id
UHC-78913-28
Confidence
1
Method
probabilistic
MBR-014779CLM-423933
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003149
Orphan claim re-pointed
Claims processor
CLM-412700 → UHC-12163-61 (Sara Wheeler)
Member id
UHC-12163-61
Confidence
0.97
Method
deterministic
MBR-006605CLM-412700
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003150
Orphan claim re-pointed
Claims processor
CLM-414239 → UHC-62249-83 (Jeffrey Alvarado)
Member id
UHC-62249-83
Confidence
1
Method
probabilistic
MBR-031075CLM-414239
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003151
Orphan claim re-pointed
Claims processor
CLM-414737 → UHC-89406-61 (Yuki Foster)
Member id
UHC-89406-61
Confidence
1
Method
probabilistic
MBR-004278CLM-414737
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003152
Orphan claim re-pointed
Claims processor
CLM-421543 → UHC-22001-33 (Megan Medina)
Member id
UHC-22001-33
Confidence
1
Method
probabilistic
MBR-007595CLM-421543
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003153
Orphan claim re-pointed
Claims processor
CLM-418833 → UHC-86924-33 (Henry Scott)
Member id
UHC-86924-33
Confidence
1
Method
probabilistic
MBR-014728CLM-418833
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003154
Orphan claim re-pointed
Claims processor
CLM-426448 → UHC-48090-22 (Mason Jacobs)
Member id
UHC-48090-22
Confidence
1
Method
probabilistic
MBR-004319CLM-426448
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003155
Orphan claim re-pointed
Claims processor
CLM-411658 → UHC-43847-07 (Lisa Sanchez)
Member id
UHC-43847-07
Confidence
1
Method
probabilistic
MBR-018703CLM-411658
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003156
Orphan claim re-pointed
Claims processor
CLM-421643 → UHC-93863-72 (Brenda Smith)
Member id
UHC-93863-72
Confidence
0.97
Method
deterministic
MBR-003244CLM-421643
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003157
Orphan claim re-pointed
Claims processor
CLM-430027 → UHC-82268-47 (Carolyn Li)
Member id
UHC-82268-47
Confidence
1
Method
probabilistic
MBR-002247CLM-430027
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003158
Orphan claim re-pointed
Claims processor
CLM-432795 → UHC-92761-01 (Stephen Murray)
Member id
UHC-92761-01
Confidence
1
Method
probabilistic
MBR-012594CLM-432795
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003159
Orphan claim re-pointed
Claims processor
CLM-407158 → UHC-17496-87 (Dylan Stewart)
Member id
UHC-17496-87
Confidence
1
Method
probabilistic
MBR-020815CLM-407158
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003160
Orphan claim re-pointed
Claims processor
CLM-414166 → UHC-04085-61 (Jessica Wang)
Member id
UHC-04085-61
Confidence
1.00
Method
probabilistic
MBR-019973CLM-414166
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003161
Orphan claim re-pointed
Claims processor
CLM-425451 → UHC-33272-26 (Raymond Grant)
Member id
UHC-33272-26
Confidence
0.97
Method
deterministic
MBR-015407CLM-425451
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003162
Orphan claim re-pointed
Claims processor
CLM-405741 → UHC-43823-71 (Bobby Mason)
Member id
UHC-43823-71
Confidence
0.97
Method
deterministic
MBR-030688CLM-405741
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003163
Orphan claim re-pointed
Claims processor
CLM-411919 → UHC-29398-05 (Julia Adams)
Member id
UHC-29398-05
Confidence
1
Method
probabilistic
MBR-006673CLM-411919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003164
Orphan claim re-pointed
Claims processor
CLM-410529 → UHC-98736-97 (Bradley Perkins)
Member id
UHC-98736-97
Confidence
1
Method
probabilistic
MBR-011639CLM-410529
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003165
Orphan claim re-pointed
Claims processor
CLM-428165 → UHC-53344-87 (Dylan King)
Member id
UHC-53344-87
Confidence
0.99
Method
probabilistic
MBR-015929CLM-428165
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003166
Orphan claim re-pointed
Claims processor
CLM-409038 → UHC-44473-39 (Allbert Hicks)
Member id
UHC-44473-39
Confidence
0.99
Method
probabilistic
MBR-015527CLM-409038
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003167
Orphan claim re-pointed
Claims processor
CLM-409547 → UHC-71447-86 (Stephanie Henderson)
Member id
UHC-71447-86
Confidence
1
Method
probabilistic
MBR-033434CLM-409547
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003168
Orphan claim re-pointed
Claims processor
CLM-431532 → UHC-64427-62 (Zachary Scott)
Member id
UHC-64427-62
Confidence
1
Method
probabilistic
MBR-004507CLM-431532
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003169
Orphan claim re-pointed
Claims processor
CLM-405451 → UHC-99272-28 (Jacob McDonald)
Member id
UHC-99272-28
Confidence
0.97
Method
deterministic
MBR-006548CLM-405451
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003170
Orphan claim re-pointed
Claims processor
CLM-430363 → UHC-76562-94 (Janet Reed)
Member id
UHC-76562-94
Confidence
1
Method
probabilistic
MBR-031290CLM-430363
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003171
Orphan claim re-pointed
Claims processor
CLM-427582 → UHC-53260-05 (Ralph Peterson)
Member id
UHC-53260-05
Confidence
1
Method
probabilistic
MBR-006611CLM-427582
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003172
Orphan claim re-pointed
Claims processor
CLM-429705 → UHC-09752-86 (Joshua Park)
Member id
UHC-09752-86
Confidence
1
Method
probabilistic
MBR-022251CLM-429705
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003173
Orphan claim re-pointed
Claims processor
CLM-414906 → UHC-54824-57 (Joe Edwardds)
Member id
UHC-54824-57
Confidence
0.97
Method
deterministic
MBR-025175CLM-414906
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003174
Orphan claim re-pointed
Claims processor
CLM-422247 → UHC-48942-70 (Janice Wong)
Member id
UHC-48942-70
Confidence
1
Method
probabilistic
MBR-027774CLM-422247
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003175
Orphan claim re-pointed
Claims processor
CLM-419942 → UHC-60747-77 (Robert Price)
Member id
UHC-60747-77
Confidence
0.97
Method
deterministic
MBR-002869CLM-419942
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003176
Orphan claim re-pointed
Claims processor
CLM-401881 → UHC-51254-08 (Patricia Wood)
Member id
UHC-51254-08
Confidence
1
Method
probabilistic
MBR-027385CLM-401881
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003177
Orphan claim re-pointed
Claims processor
CLM-428146 → UHC-37090-48 (Mei Tran)
Member id
UHC-37090-48
Confidence
1
Method
probabilistic
MBR-014722CLM-428146
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003178
Orphan claim re-pointed
Claims processor
CLM-414795 → UHC-80952-81 (Pamela Butler)
Member id
UHC-80952-81
Confidence
0.99
Method
probabilistic
MBR-011664CLM-414795
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003179
Orphan claim re-pointed
Claims processor
CLM-419260 → UHC-44427-94 (Stephen Grant)
Member id
UHC-44427-94
Confidence
1
Method
probabilistic
MBR-020418CLM-419260
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003180
Orphan claim re-pointed
Claims processor
CLM-418919 → UHC-08048-85 (Melissa Harvey)
Member id
UHC-08048-85
Confidence
1
Method
probabilistic
MBR-022498CLM-418919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003181
Orphan claim re-pointed
Claims processor
CLM-421620 → UHC-86083-05 (Teresa Chavez)
Member id
UHC-86083-05
Confidence
1.00
Method
probabilistic
MBR-006342CLM-421620
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003182
Orphan claim re-pointed
Claims processor
CLM-418873 → UHC-44238-24 (Joseph Webb)
Member id
UHC-44238-24
Confidence
0.97
Method
deterministic
MBR-010315CLM-418873
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003183
Orphan claim re-pointed
Claims processor
CLM-408331 → UHC-50574-71 (Rebecca Wilson)
Member id
UHC-50574-71
Confidence
0.97
Method
deterministic
MBR-011231CLM-408331
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003184
Orphan claim re-pointed
Claims processor
CLM-402723 → UHC-35765-08 (Gerald Jones)
Member id
UHC-35765-08
Confidence
0.99
Method
probabilistic
MBR-037013CLM-402723
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003185
Orphan claim re-pointed
Claims processor
CLM-403970 → UHC-48286-43 (Kenneth Tucker)
Member id
UHC-48286-43
Confidence
1
Method
probabilistic
MBR-021246CLM-403970
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003186
Orphan claim re-pointed
Claims processor
CLM-406890 → UHC-96152-36 (Priya Cook)
Member id
UHC-96152-36
Confidence
1
Method
probabilistic
MBR-006563CLM-406890
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003187
Orphan claim re-pointed
Claims processor
CLM-412126 → UHC-98227-66 (Fatima Robertson)
Member id
UHC-98227-66
Confidence
0.97
Method
deterministic
MBR-008964CLM-412126
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003188
Orphan claim re-pointed
Claims processor
CLM-429234 → UHC-11118-67 (Natalie Bennett)
Member id
UHC-11118-67
Confidence
1
Method
probabilistic
MBR-021349CLM-429234
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003189
Orphan claim re-pointed
Claims processor
CLM-408969 → UHC-27109-52 (Megan Bradley)
Member id
UHC-27109-52
Confidence
1
Method
probabilistic
MBR-001625CLM-408969
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 37 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.