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-003640
Orphan claim re-pointed
Claims processor
CLM-432759 → UHC-82685-52 (Randy Nunez)
Member id
UHC-82685-52
Confidence
1
Method
probabilistic
MBR-042589CLM-432759
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003641
Orphan claim re-pointed
Claims processor
CLM-410499 → UHC-93692-17 (Isabella Ramirez)
Member id
UHC-93692-17
Confidence
1
Method
probabilistic
MBR-031437CLM-410499
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003642
Orphan claim re-pointed
Claims processor
CLM-412023 → UHC-91736-60 (Randy Sims)
Member id
UHC-91736-60
Confidence
1
Method
probabilistic
MBR-012073CLM-412023
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003643
Orphan claim re-pointed
Claims processor
CLM-427697 → UHC-53069-38 (Billy Henderson)
Member id
UHC-53069-38
Confidence
1
Method
probabilistic
MBR-002934CLM-427697
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003644
Orphan claim re-pointed
Claims processor
CLM-408604 → UHC-10171-50 (Robert Palmer)
Member id
UHC-10171-50
Confidence
0.97
Method
deterministic
MBR-001934CLM-408604
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003645
Orphan claim re-pointed
Claims processor
CLM-404533 → UHC-53774-63 (Hiroshi Kelley)
Member id
UHC-53774-63
Confidence
1
Method
probabilistic
MBR-022485CLM-404533
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003646
Orphan claim re-pointed
Claims processor
CLM-415101 → UHC-24537-63 (Michelle Lee)
Member id
UHC-24537-63
Confidence
0.93
Method
probabilistic
MBR-019450CLM-415101
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003647
Orphan claim re-pointed
Claims processor
CLM-405483 → UHC-96934-23 (Thomas Powell)
Member id
UHC-96934-23
Confidence
1
Method
probabilistic
MBR-019887CLM-405483
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003648
Orphan claim re-pointed
Claims processor
CLM-420815 → UHC-62165-37 (Alexander Harris)
Member id
UHC-62165-37
Confidence
0.97
Method
deterministic
MBR-024086CLM-420815
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003649
Orphan claim re-pointed
Claims processor
CLM-421897 → UHC-32702-07 (Martha Watson)
Member id
UHC-32702-07
Confidence
0.93
Method
probabilistic
MBR-020296CLM-421897
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003650
Orphan claim re-pointed
Claims processor
CLM-402249 → UHC-27907-28 (Charlotte Alvarez)
Member id
UHC-27907-28
Confidence
1
Method
probabilistic
MBR-034019CLM-402249
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003651
Orphan claim re-pointed
Claims processor
CLM-422591 → UHC-73740-43 (Julie Ryan)
Member id
UHC-73740-43
Confidence
0.97
Method
deterministic
MBR-011723CLM-422591
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003652
Orphan claim re-pointed
Claims processor
CLM-414483 → UHC-36583-04 (Joan Torres)
Member id
UHC-36583-04
Confidence
0.99
Method
probabilistic
MBR-006817CLM-414483
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003653
Orphan claim re-pointed
Claims processor
CLM-404782 → UHC-06843-43 (Mateo Jensen)
Member id
UHC-06843-43
Confidence
1
Method
probabilistic
MBR-037366CLM-404782
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003654
Orphan claim re-pointed
Claims processor
CLM-409622 → UHC-67568-05 (Larry Moore)
Member id
UHC-67568-05
Confidence
0.97
Method
deterministic
MBR-005293CLM-409622
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003655
Orphan claim re-pointed
Claims processor
CLM-424788 → UHC-30287-02 (Camila Coleman)
Member id
UHC-30287-02
Confidence
1
Method
probabilistic
MBR-000095CLM-424788
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003656
Orphan claim re-pointed
Claims processor
CLM-421432 → UHC-17147-62 (Lucia Vazquez)
Member id
UHC-17147-62
Confidence
1
Method
probabilistic
MBR-031282CLM-421432
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003657
Orphan claim re-pointed
Claims processor
CLM-425631 → UHC-08115-31 (Emily Dunn)
Member id
UHC-08115-31
Confidence
1
Method
probabilistic
MBR-005095CLM-425631
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003658
Orphan claim re-pointed
Claims processor
CLM-422605 → UHC-33618-37 (Dylan Ramos)
Member id
UHC-33618-37
Confidence
1
Method
probabilistic
MBR-015610CLM-422605
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003659
Orphan claim re-pointed
Claims processor
CLM-423888 → UHC-91198-73 (Judy Montgomery)
Member id
UHC-91198-73
Confidence
1
Method
probabilistic
MBR-004286CLM-423888
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003660
Orphan claim re-pointed
Claims processor
CLM-422023 → UHC-79280-23 (Ryan Edwards)
Member id
UHC-79280-23
Confidence
1
Method
probabilistic
MBR-006135CLM-422023
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003661
Orphan claim re-pointed
Claims processor
CLM-428836 → UHC-77677-08 (Ashley Walsh)
Member id
UHC-77677-08
Confidence
0.93
Method
probabilistic
MBR-013463CLM-428836
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003662
Orphan claim re-pointed
Claims processor
CLM-421805 → UHC-53009-43 (Helen Watson)
Member id
UHC-53009-43
Confidence
1
Method
probabilistic
MBR-013206CLM-421805
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003663
Orphan claim re-pointed
Claims processor
CLM-405989 → UHC-44961-96 (Joshua Marshall)
Member id
UHC-44961-96
Confidence
1
Method
probabilistic
MBR-004664CLM-405989
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003664
Orphan claim re-pointed
Claims processor
CLM-409659 → UHC-58614-40 (Alexander Wells)
Member id
UHC-58614-40
Confidence
1
Method
probabilistic
MBR-030523CLM-409659
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003665
Orphan claim re-pointed
Claims processor
CLM-427248 → UHC-50874-41 (Bruce Vega)
Member id
UHC-50874-41
Confidence
0.98
Method
probabilistic
MBR-027039CLM-427248
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003666
Orphan claim re-pointed
Claims processor
CLM-410039 → UHC-72396-45 (Jason Mills)
Member id
UHC-72396-45
Confidence
1
Method
probabilistic
MBR-003404CLM-410039
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003667
Orphan claim re-pointed
Claims processor
CLM-409229 → UHC-28152-67 (Joe Castillo)
Member id
UHC-28152-67
Confidence
1
Method
probabilistic
MBR-007770CLM-409229
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003668
Orphan claim re-pointed
Claims processor
CLM-423702 → UHC-81831-31 (Kathleen Day)
Member id
UHC-81831-31
Confidence
1
Method
probabilistic
MBR-017970CLM-423702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003669
Orphan claim re-pointed
Claims processor
CLM-423118 → UHC-47110-21 (Barbara Reed)
Member id
UHC-47110-21
Confidence
0.94
Method
probabilistic
MBR-007366CLM-423118
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003670
Orphan claim re-pointed
Claims processor
CLM-406790 → UHC-28167-34 (Jacqueline Burke)
Member id
UHC-28167-34
Confidence
1
Method
probabilistic
MBR-000596CLM-406790
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003671
Orphan claim re-pointed
Claims processor
CLM-411670 → UHC-67995-44 (Donna Stephens)
Member id
UHC-67995-44
Confidence
1
Method
probabilistic
MBR-007193CLM-411670
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003672
Orphan claim re-pointed
Claims processor
CLM-417822 → UHC-89751-57 (Aisha Nguyen)
Member id
UHC-89751-57
Confidence
0.97
Method
deterministic
MBR-034691CLM-417822
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003673
Orphan claim re-pointed
Claims processor
CLM-403008 → UHC-91652-15 (Ryan Little)
Member id
UHC-91652-15
Confidence
0.97
Method
deterministic
MBR-003074CLM-403008
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003674
Orphan claim re-pointed
Claims processor
CLM-422829 → UHC-77203-39 (Elijah Young)
Member id
UHC-77203-39
Confidence
0.97
Method
deterministic
MBR-003260CLM-422829
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003675
Orphan claim re-pointed
Claims processor
CLM-405768 → UHC-27527-73 (Henry Mendez)
Member id
UHC-27527-73
Confidence
0.93
Method
probabilistic
MBR-036163CLM-405768
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003676
Orphan claim re-pointed
Claims processor
CLM-415123 → UHC-96249-54 (Timothy Brooks)
Member id
UHC-96249-54
Confidence
1
Method
probabilistic
MBR-015364CLM-415123
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003677
Orphan claim re-pointed
Claims processor
CLM-421001 → UHC-02986-81 (Tyler Reed)
Member id
UHC-02986-81
Confidence
1
Method
probabilistic
MBR-012953CLM-421001
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003678
Orphan claim re-pointed
Claims processor
CLM-402132 → UHC-01248-43 (Diane Stone)
Member id
UHC-01248-43
Confidence
1
Method
probabilistic
MBR-023077CLM-402132
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003679
Orphan claim re-pointed
Claims processor
CLM-419903 → UHC-69124-67 (Kathryn Robinson)
Member id
UHC-69124-67
Confidence
1
Method
probabilistic
MBR-003509CLM-419903
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003680
Orphan claim re-pointed
Claims processor
CLM-424012 → UHC-97185-04 (Marcus Ramirez)
Member id
UHC-97185-04
Confidence
1
Method
probabilistic
MBR-029734CLM-424012
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003681
Orphan claim re-pointed
Claims processor
CLM-401254 → UHC-20075-24 (Maria Washington)
Member id
UHC-20075-24
Confidence
1
Method
probabilistic
MBR-022549CLM-401254
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003682
Orphan claim re-pointed
Claims processor
CLM-428231 → UHC-45079-43 (Jerry Dunn)
Member id
UHC-45079-43
Confidence
1
Method
probabilistic
MBR-006905CLM-428231
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003683
Orphan claim re-pointed
Claims processor
CLM-417403 → UHC-29632-13 (Terry Le)
Member id
UHC-29632-13
Confidence
1
Method
probabilistic
MBR-035023CLM-417403
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003684
Orphan claim re-pointed
Claims processor
CLM-404071 → UHC-81271-92 (Ryan Jimenez)
Member id
UHC-81271-92
Confidence
1
Method
probabilistic
MBR-011638CLM-404071
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003685
Orphan claim re-pointed
Claims processor
CLM-401546 → UHC-15951-28 (Michael Clark)
Member id
UHC-15951-28
Confidence
1
Method
probabilistic
MBR-017910CLM-401546
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003686
Orphan claim re-pointed
Claims processor
CLM-401003 → UHC-52621-90 (Charles Kelly)
Member id
UHC-52621-90
Confidence
0.93
Method
probabilistic
MBR-009796CLM-401003
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003687
Orphan claim re-pointed
Claims processor
CLM-418217 → UHC-15372-66 (Jason Murphy)
Member id
UHC-15372-66
Confidence
0.99
Method
probabilistic
MBR-004902CLM-418217
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003688
Orphan claim re-pointed
Claims processor
CLM-412241 → UHC-40023-82 (Victoria Ross)
Member id
UHC-40023-82
Confidence
1
Method
probabilistic
MBR-007791CLM-412241
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003689
Orphan claim re-pointed
Claims processor
CLM-430699 → UHC-62633-54 (Alexnader Le)
Member id
UHC-62633-54
Confidence
0.99
Method
probabilistic
MBR-029118CLM-430699
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 47 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.