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-001540
Orphan claim re-pointed
Claims processor
CLM-403638 → UHC-81471-19 (Nicole Wood)
Member id
UHC-81471-19
Confidence
1
Method
probabilistic
MBR-002023CLM-403638
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001541
Orphan claim re-pointed
Claims processor
CLM-400900 → UHC-70464-74 (Gary Valdez)
Member id
UHC-70464-74
Confidence
0.97
Method
deterministic
MBR-028237CLM-400900
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001542
Orphan claim re-pointed
Claims processor
CLM-407428 → UHC-30601-68 (Kenneth Chavez)
Member id
UHC-30601-68
Confidence
0.97
Method
deterministic
MBR-027230CLM-407428
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001543
Orphan claim re-pointed
Claims processor
CLM-420564 → UHC-97571-27 (Vincent Gutierrez)
Member id
UHC-97571-27
Confidence
0.97
Method
deterministic
MBR-042736CLM-420564
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001544
Orphan claim re-pointed
Claims processor
CLM-401879 → UHC-51254-08 (Patricia Wood)
Member id
UHC-51254-08
Confidence
1
Method
probabilistic
MBR-027385CLM-401879
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001545
Orphan claim re-pointed
Claims processor
CLM-415177 → UHC-59069-95 (Peter Alexander)
Member id
UHC-59069-95
Confidence
0.97
Method
deterministic
MBR-003936CLM-415177
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001546
Orphan claim re-pointed
Claims processor
CLM-426668 → UHC-71604-82 (Ana Lee)
Member id
UHC-71604-82
Confidence
1
Method
probabilistic
MBR-031901CLM-426668
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001547
Orphan claim re-pointed
Claims processor
CLM-419683 → UHC-04711-59 (Dorothy Lawrence)
Member id
UHC-04711-59
Confidence
1
Method
probabilistic
MBR-015146CLM-419683
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001548
Orphan claim re-pointed
Claims processor
CLM-428229 → UHC-42145-76 (Bryan Foster)
Member id
UHC-42145-76
Confidence
1
Method
probabilistic
MBR-003172CLM-428229
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001549
Orphan claim re-pointed
Claims processor
CLM-413005 → UHC-73108-23 (Lauren Valdez)
Member id
UHC-73108-23
Confidence
0.97
Method
deterministic
MBR-040989CLM-413005
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001550
Orphan claim re-pointed
Claims processor
CLM-400811 → UHC-21934-36 (Brandon Russell)
Member id
UHC-21934-36
Confidence
0.97
Method
deterministic
MBR-019074CLM-400811
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001551
Orphan claim re-pointed
Claims processor
CLM-423257 → UHC-59331-75 (Mark Howell)
Member id
UHC-59331-75
Confidence
0.97
Method
deterministic
MBR-005541CLM-423257
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001552
Orphan claim re-pointed
Claims processor
CLM-429918 → UHC-95888-71 (Ana McCoy)
Member id
UHC-95888-71
Confidence
0.97
Method
deterministic
MBR-039127CLM-429918
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001553
Orphan claim re-pointed
Claims processor
CLM-401105 → UHC-16502-55 (Sara James)
Member id
UHC-16502-55
Confidence
0.98
Method
probabilistic
MBR-013161CLM-401105
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001554
Orphan claim re-pointed
Claims processor
CLM-422049 → UHC-73484-68 (Eric Hall)
Member id
UHC-73484-68
Confidence
0.98
Method
probabilistic
MBR-022895CLM-422049
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001555
Orphan claim re-pointed
Claims processor
CLM-416581 → UHC-04462-47 (Mason Ramirez)
Member id
UHC-04462-47
Confidence
0.99
Method
probabilistic
MBR-001938CLM-416581
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001556
Orphan claim re-pointed
Claims processor
CLM-407577 → UHC-14958-17 (Mateo Salazar)
Member id
UHC-14958-17
Confidence
1
Method
probabilistic
MBR-029474CLM-407577
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001557
Orphan claim re-pointed
Claims processor
CLM-415988 → UHC-34995-40 (Teresa Reyes)
Member id
UHC-34995-40
Confidence
1
Method
probabilistic
MBR-040347CLM-415988
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001558
Orphan claim re-pointed
Claims processor
CLM-420748 → UHC-05632-94 (Walter Hernandez)
Member id
UHC-05632-94
Confidence
0.97
Method
deterministic
MBR-007723CLM-420748
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001559
Orphan claim re-pointed
Claims processor
CLM-408990 → UHC-64589-54 (Ashley Hansen)
Member id
UHC-64589-54
Confidence
1
Method
probabilistic
MBR-000594CLM-408990
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001560
Orphan claim re-pointed
Claims processor
CLM-416312 → UHC-78882-41 (Kathleen Johnston)
Member id
UHC-78882-41
Confidence
0.97
Method
deterministic
MBR-009752CLM-416312
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001561
Orphan claim re-pointed
Claims processor
CLM-405233 → UHC-52836-55 (Victoria Hawkins)
Member id
UHC-52836-55
Confidence
0.97
Method
deterministic
MBR-018388CLM-405233
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001562
Orphan claim re-pointed
Claims processor
CLM-412316 → UHC-80658-32 (John Burke)
Member id
UHC-80658-32
Confidence
0.97
Method
deterministic
MBR-019321CLM-412316
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001563
Orphan claim re-pointed
Claims processor
CLM-427026 → UHC-51192-01 (Megan Grant)
Member id
UHC-51192-01
Confidence
1
Method
probabilistic
MBR-012447CLM-427026
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001564
Orphan claim re-pointed
Claims processor
CLM-425745 → UHC-11038-16 (Li Li)
Member id
UHC-11038-16
Confidence
0.99
Method
probabilistic
MBR-023628CLM-425745
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001565
Orphan claim re-pointed
Claims processor
CLM-401137 → UHC-27759-35 (Natalie Williams)
Member id
UHC-27759-35
Confidence
1
Method
probabilistic
MBR-002986CLM-401137
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001566
Orphan claim re-pointed
Claims processor
CLM-417430 → UHC-97871-08 (Maria Jenkins)
Member id
UHC-97871-08
Confidence
0.94
Method
probabilistic
MBR-022457CLM-417430
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001567
Orphan claim re-pointed
Claims processor
CLM-421779 → UHC-68512-24 (Rachel Anderson)
Member id
UHC-68512-24
Confidence
0.97
Method
deterministic
MBR-016180CLM-421779
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001568
Orphan claim re-pointed
Claims processor
CLM-403482 → UHC-38295-18 (Nicole Lucas)
Member id
UHC-38295-18
Confidence
1
Method
probabilistic
MBR-035714CLM-403482
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001569
Orphan claim re-pointed
Claims processor
CLM-418200 → UHC-57655-78 (Laura Guzman)
Member id
UHC-57655-78
Confidence
1
Method
probabilistic
MBR-022803CLM-418200
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001570
Orphan claim re-pointed
Claims processor
CLM-419890 → UHC-50533-10 (Elijah Adams)
Member id
UHC-50533-10
Confidence
1
Method
probabilistic
MBR-004023CLM-419890
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001571
Orphan claim re-pointed
Claims processor
CLM-409058 → UHC-66414-72 (Aisha Long)
Member id
UHC-66414-72
Confidence
1
Method
probabilistic
MBR-026565CLM-409058
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001572
Orphan claim re-pointed
Claims processor
CLM-421412 → UHC-39923-61 (Stephen Jimenez)
Member id
UHC-39923-61
Confidence
1
Method
probabilistic
MBR-010035CLM-421412
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001573
Orphan claim re-pointed
Claims processor
CLM-427736 → UHC-07805-06 (Lucia Hughes)
Member id
UHC-07805-06
Confidence
0.97
Method
deterministic
MBR-028977CLM-427736
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001574
Orphan claim re-pointed
Claims processor
CLM-403309 → UHC-36773-55 (Judy Harvey)
Member id
UHC-36773-55
Confidence
1
Method
probabilistic
MBR-030348CLM-403309
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001575
Orphan claim re-pointed
Claims processor
CLM-410828 → UHC-08400-52 (Justin Estrada)
Member id
UHC-08400-52
Confidence
0.97
Method
deterministic
MBR-000054CLM-410828
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001576
Orphan claim re-pointed
Claims processor
CLM-400234 → UHC-96990-15 (Angela Espinoza)
Member id
UHC-96990-15
Confidence
0.99
Method
probabilistic
MBR-017663CLM-400234
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001577
Orphan claim re-pointed
Claims processor
CLM-418722 → UHC-11833-22 (Ralph Bell)
Member id
UHC-11833-22
Confidence
0.99
Method
probabilistic
MBR-034841CLM-418722
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001578
Orphan claim re-pointed
Claims processor
CLM-411576 → UHC-66914-34 (Kyle Ortega)
Member id
UHC-66914-34
Confidence
1
Method
probabilistic
MBR-021980CLM-411576
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001579
Orphan claim re-pointed
Claims processor
CLM-431535 → UHC-98440-07 (Amanda Li)
Member id
UHC-98440-07
Confidence
1
Method
probabilistic
MBR-033044CLM-431535
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001580
Orphan claim re-pointed
Claims processor
CLM-400835 → UHC-82880-52 (Julie Webb)
Member id
UHC-82880-52
Confidence
0.97
Method
deterministic
MBR-012565CLM-400835
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001581
Orphan claim re-pointed
Claims processor
CLM-402587 → UHC-34799-44 (Jennifer Oliver)
Member id
UHC-34799-44
Confidence
1
Method
probabilistic
MBR-017493CLM-402587
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001582
Orphan claim re-pointed
Claims processor
CLM-414941 → UHC-74433-78 (Benjamin Contreras)
Member id
UHC-74433-78
Confidence
1
Method
probabilistic
MBR-013639CLM-414941
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001583
Orphan claim re-pointed
Claims processor
CLM-412479 → UHC-55006-25 (Samuel Kelley)
Member id
UHC-55006-25
Confidence
0.97
Method
deterministic
MBR-011228CLM-412479
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001584
Orphan claim re-pointed
Claims processor
CLM-411960 → UHC-81594-20 (Pamela Ortega)
Member id
UHC-81594-20
Confidence
1
Method
probabilistic
MBR-027731CLM-411960
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001585
Orphan claim re-pointed
Claims processor
CLM-405970 → UHC-91270-07 (Larry Bowman)
Member id
UHC-91270-07
Confidence
0.97
Method
deterministic
MBR-019835CLM-405970
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001586
Orphan claim re-pointed
Claims processor
CLM-431778 → UHC-23575-96 (Ashley Carter)
Member id
UHC-23575-96
Confidence
0.97
Method
deterministic
MBR-028591CLM-431778
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001587
Orphan claim re-pointed
Claims processor
CLM-430226 → UHC-66078-28 (Aisha Gray)
Member id
UHC-66078-28
Confidence
1
Method
probabilistic
MBR-022080CLM-430226
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001588
Orphan claim re-pointed
Claims processor
CLM-409995 → UHC-15361-56 (Jean Williamson)
Member id
UHC-15361-56
Confidence
1
Method
probabilistic
MBR-003613CLM-409995
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001589
Orphan claim re-pointed
Claims processor
CLM-429356 → UHC-30144-81 (Janet Weaver)
Member id
UHC-30144-81
Confidence
1
Method
probabilistic
MBR-009403CLM-429356
Executed
resolution_agent
2026-10-19 19:54:39
14,086 rows, page 5 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.