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-003790
Orphan claim re-pointed
Claims processor
CLM-430391 → UHC-38492-32 (Keith Kennedy)
Member id
UHC-38492-32
Confidence
1
Method
probabilistic
MBR-006349CLM-430391
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003791
Orphan claim re-pointed
Claims processor
CLM-408003 → UHC-11590-49 (Dennis Gilbert)
Member id
UHC-11590-49
Confidence
1
Method
probabilistic
MBR-003858CLM-408003
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003792
Orphan claim re-pointed
Claims processor
CLM-412459 → UHC-93376-76 (Amy Williiamson)
Member id
UHC-93376-76
Confidence
1.00
Method
probabilistic
MBR-016250CLM-412459
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003793
Orphan claim re-pointed
Claims processor
CLM-423785 → UHC-24207-80 (Douglas Reynolds)
Member id
UHC-24207-80
Confidence
1
Method
probabilistic
MBR-032080CLM-423785
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003794
Orphan claim re-pointed
Claims processor
CLM-403711 → UHC-01356-46 (Keith Vazquez)
Member id
UHC-01356-46
Confidence
1
Method
probabilistic
MBR-012139CLM-403711
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003795
Orphan claim re-pointed
Claims processor
CLM-404941 → UHC-18678-37 (Carlos Brooks)
Member id
UHC-18678-37
Confidence
1
Method
probabilistic
MBR-016318CLM-404941
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003796
Orphan claim re-pointed
Claims processor
CLM-431280 → UHC-51097-46 (Hannah Ramos)
Member id
UHC-51097-46
Confidence
1
Method
probabilistic
MBR-009209CLM-431280
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003797
Orphan claim re-pointed
Claims processor
CLM-432341 → UHC-37561-39 (Walter Rice)
Member id
UHC-37561-39
Confidence
1
Method
probabilistic
MBR-004065CLM-432341
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003798
Orphan claim re-pointed
Claims processor
CLM-409044 → UHC-09446-73 (Doris Ford)
Member id
UHC-09446-73
Confidence
0.99
Method
probabilistic
MBR-019908CLM-409044
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003799
Orphan claim re-pointed
Claims processor
CLM-401940 → UHC-82412-81 (Emma Munoz)
Member id
UHC-82412-81
Confidence
0.97
Method
deterministic
MBR-020142CLM-401940
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003800
Orphan claim re-pointed
Claims processor
CLM-426469 → UHC-81117-27 (Bobby Dean)
Member id
UHC-81117-27
Confidence
1
Method
probabilistic
MBR-010053CLM-426469
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003801
Orphan claim re-pointed
Claims processor
CLM-413071 → UHC-96798-08 (Roy Munoz)
Member id
UHC-96798-08
Confidence
1
Method
probabilistic
MBR-031877CLM-413071
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003802
Orphan claim re-pointed
Claims processor
CLM-414602 → UHC-16998-40 (Sharon Guzman)
Member id
UHC-16998-40
Confidence
0.97
Method
deterministic
MBR-030935CLM-414602
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003803
Orphan claim re-pointed
Claims processor
CLM-426369 → UHC-85206-38 (Abigail Carr)
Member id
UHC-85206-38
Confidence
1
Method
probabilistic
MBR-031137CLM-426369
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003804
Orphan claim re-pointed
Claims processor
CLM-411768 → UHC-90090-71 (Alice Price)
Member id
UHC-90090-71
Confidence
1
Method
probabilistic
MBR-007903CLM-411768
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003805
Orphan claim re-pointed
Claims processor
CLM-427578 → UHC-61675-14 (Diane Ortega)
Member id
UHC-61675-14
Confidence
0.99
Method
probabilistic
MBR-009449CLM-427578
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003806
Orphan claim re-pointed
Claims processor
CLM-410352 → UHC-71413-86 (Sophia Riley)
Member id
UHC-71413-86
Confidence
1
Method
probabilistic
MBR-001208CLM-410352
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003807
Orphan claim re-pointed
Claims processor
CLM-421632 → UHC-67576-88 (Will Burton)
Member id
UHC-67576-88
Confidence
0.86
Method
probabilistic
MBR-015513CLM-421632
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003808
Orphan claim re-pointed
Claims processor
CLM-402696 → UHC-47088-15 (Anthony Martin)
Member id
UHC-47088-15
Confidence
0.93
Method
probabilistic
MBR-007695CLM-402696
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003809
Orphan claim re-pointed
Claims processor
CLM-407498 → UHC-94395-87 (Peter Fowler)
Member id
UHC-94395-87
Confidence
1
Method
probabilistic
MBR-003925CLM-407498
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003810
Orphan claim re-pointed
Claims processor
CLM-403851 → UHC-60731-35 (Larry Arnold)
Member id
UHC-60731-35
Confidence
1
Method
probabilistic
MBR-009807CLM-403851
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003811
Orphan claim re-pointed
Claims processor
CLM-422684 → UHC-07366-97 (Diego Richardson)
Member id
UHC-07366-97
Confidence
0.97
Method
deterministic
MBR-000866CLM-422684
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003812
Orphan claim re-pointed
Claims processor
CLM-431901 → UHC-38371-52 (Margaret Fernandez)
Member id
UHC-38371-52
Confidence
0.97
Method
deterministic
MBR-014857CLM-431901
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003813
Orphan claim re-pointed
Claims processor
CLM-425706 → UHC-52231-59 (Ahmed Watkins)
Member id
UHC-52231-59
Confidence
1
Method
probabilistic
MBR-023453CLM-425706
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003814
Orphan claim re-pointed
Claims processor
CLM-430626 → UHC-76455-82 (Edward Hunt)
Member id
UHC-76455-82
Confidence
1
Method
probabilistic
MBR-016058CLM-430626
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003815
Orphan claim re-pointed
Claims processor
CLM-432469 → UHC-34320-97 (Aaron Salazar)
Member id
UHC-34320-97
Confidence
1
Method
probabilistic
MBR-018490CLM-432469
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003816
Orphan claim re-pointed
Claims processor
CLM-423907 → UHC-85849-89 (Maria Jenkins)
Member id
UHC-85849-89
Confidence
1
Method
probabilistic
MBR-013883CLM-423907
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003817
Orphan claim re-pointed
Claims processor
CLM-405725 → UHC-66409-87 (Frank Parker)
Member id
UHC-66409-87
Confidence
0.97
Method
deterministic
MBR-042094CLM-405725
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003818
Orphan claim re-pointed
Claims processor
CLM-424139 → UHC-07458-97 (Sofia Walker)
Member id
UHC-07458-97
Confidence
0.86
Method
probabilistic
MBR-002935CLM-424139
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003819
Orphan claim re-pointed
Claims processor
CLM-412511 → UHC-25407-01 (Kyle Jensen)
Member id
UHC-25407-01
Confidence
1
Method
probabilistic
MBR-019229CLM-412511
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003820
Orphan claim re-pointed
Claims processor
CLM-407285 → UHC-71067-71 (Carl Torres)
Member id
UHC-71067-71
Confidence
1
Method
probabilistic
MBR-041156CLM-407285
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003821
Orphan claim re-pointed
Claims processor
CLM-400047 → UHC-06704-09 (Sandra Rice)
Member id
UHC-06704-09
Confidence
1
Method
probabilistic
MBR-024266CLM-400047
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003822
Orphan claim re-pointed
Claims processor
CLM-416430 → UHC-70271-69 (Ann Luna)
Member id
UHC-70271-69
Confidence
1
Method
probabilistic
MBR-011889CLM-416430
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003823
Orphan claim re-pointed
Claims processor
CLM-409375 → UHC-49727-75 (Ralph Pierce)
Member id
UHC-49727-75
Confidence
1
Method
probabilistic
MBR-022975CLM-409375
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003824
Orphan claim re-pointed
Claims processor
CLM-404592 → UHC-08657-37 (Jason King)
Member id
UHC-08657-37
Confidence
1
Method
probabilistic
MBR-011674CLM-404592
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003825
Orphan claim re-pointed
Claims processor
CLM-407770 → UHC-00633-60 (Noah Miller)
Member id
UHC-00633-60
Confidence
1
Method
probabilistic
MBR-002977CLM-407770
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003826
Orphan claim re-pointed
Claims processor
CLM-431707 → UHC-56875-41 (Christine Wallace)
Member id
UHC-56875-41
Confidence
1
Method
probabilistic
MBR-000404CLM-431707
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003827
Orphan claim re-pointed
Claims processor
CLM-424985 → UHC-14487-06 (Grace Lane)
Member id
UHC-14487-06
Confidence
0.97
Method
deterministic
MBR-026918CLM-424985
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003828
Orphan claim re-pointed
Claims processor
CLM-411246 → UHC-41677-84 (Steven Phillips)
Member id
UHC-41677-84
Confidence
0.98
Method
probabilistic
MBR-012303CLM-411246
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003829
Orphan claim re-pointed
Claims processor
CLM-413976 → UHC-32060-55 (Christina Owens)
Member id
UHC-32060-55
Confidence
0.99
Method
probabilistic
MBR-011319CLM-413976
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003830
Orphan claim re-pointed
Claims processor
CLM-401597 → UHC-21240-90 (Brandon Porter)
Member id
UHC-21240-90
Confidence
0.91
Method
probabilistic
MBR-021518CLM-401597
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003831
Orphan claim re-pointed
Claims processor
CLM-403347 → UHC-72868-40 (Sofia Vargas)
Member id
UHC-72868-40
Confidence
1
Method
probabilistic
MBR-006981CLM-403347
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003832
Orphan claim re-pointed
Claims processor
CLM-412697 → UHC-82671-87 (Virginia Porter)
Member id
UHC-82671-87
Confidence
1
Method
probabilistic
MBR-009586CLM-412697
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003833
Orphan claim re-pointed
Claims processor
CLM-426898 → UHC-76883-32 (Ethan Rogers)
Member id
UHC-76883-32
Confidence
1
Method
probabilistic
MBR-004933CLM-426898
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003834
Orphan claim re-pointed
Claims processor
CLM-418170 → UHC-18712-38 (Gerald Henderson)
Member id
UHC-18712-38
Confidence
0.97
Method
deterministic
MBR-004528CLM-418170
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003835
Orphan claim re-pointed
Claims processor
CLM-409857 → UHC-76932-93 (Eric Fisher)
Member id
UHC-76932-93
Confidence
1
Method
probabilistic
MBR-005107CLM-409857
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003836
Orphan claim re-pointed
Claims processor
CLM-419907 → UHC-09379-62 (Lisa Dunn)
Member id
UHC-09379-62
Confidence
0.97
Method
deterministic
MBR-041809CLM-419907
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003837
Orphan claim re-pointed
Claims processor
CLM-410537 → UHC-61330-54 (Adam Bailey)
Member id
UHC-61330-54
Confidence
1
Method
probabilistic
MBR-008534CLM-410537
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003838
Orphan claim re-pointed
Claims processor
CLM-431536 → UHC-98440-07 (Amanda Li)
Member id
UHC-98440-07
Confidence
1
Method
probabilistic
MBR-033044CLM-431536
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003839
Orphan claim re-pointed
Claims processor
CLM-426279 → UHC-67538-62 (Donald Morales)
Member id
UHC-67538-62
Confidence
1
Method
probabilistic
MBR-014058CLM-426279
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 50 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.