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-003840
Orphan claim re-pointed
Claims processor
CLM-420039 → UHC-96523-84 (Kayla Cole)
Member id
UHC-96523-84
Confidence
1
Method
probabilistic
MBR-013700CLM-420039
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003841
Orphan claim re-pointed
Claims processor
CLM-414874 → UHC-06004-43 (Wei Romero)
Member id
UHC-06004-43
Confidence
1
Method
probabilistic
MBR-021169CLM-414874
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003842
Orphan claim re-pointed
Claims processor
CLM-424488 → UHC-59681-63 (Douglas Stephens)
Member id
UHC-59681-63
Confidence
1
Method
probabilistic
MBR-006488CLM-424488
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003843
Orphan claim re-pointed
Claims processor
CLM-426078 → UHC-23575-28 (Lauren Peters)
Member id
UHC-23575-28
Confidence
1
Method
probabilistic
MBR-009118CLM-426078
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003844
Orphan claim re-pointed
Claims processor
CLM-404108 → UHC-34223-83 (Carol Stevens)
Member id
UHC-34223-83
Confidence
0.98
Method
probabilistic
MBR-025490CLM-404108
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003845
Orphan claim re-pointed
Claims processor
CLM-426461 → UHC-23862-12 (Heather Long)
Member id
UHC-23862-12
Confidence
1.00
Method
probabilistic
MBR-009822CLM-426461
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003846
Orphan claim re-pointed
Claims processor
CLM-419795 → UHC-32104-52 (Patricia Fox)
Member id
UHC-32104-52
Confidence
0.97
Method
deterministic
MBR-025384CLM-419795
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003847
Orphan claim re-pointed
Claims processor
CLM-401521 → UHC-93729-34 (Gloria Perry)
Member id
UHC-93729-34
Confidence
0.99
Method
probabilistic
MBR-014602CLM-401521
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003848
Orphan claim re-pointed
Claims processor
CLM-403087 → UHC-95054-93 (Valentina Banks)
Member id
UHC-95054-93
Confidence
1
Method
probabilistic
MBR-005548CLM-403087
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003849
Orphan claim re-pointed
Claims processor
CLM-405085 → UHC-84948-25 (Judith Lopez)
Member id
UHC-84948-25
Confidence
1
Method
probabilistic
MBR-003221CLM-405085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003850
Orphan claim re-pointed
Claims processor
CLM-407300 → UHC-08247-33 (Rachel Crawford)
Member id
UHC-08247-33
Confidence
1
Method
probabilistic
MBR-013249CLM-407300
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003851
Orphan claim re-pointed
Claims processor
CLM-414193 → UHC-19695-21 (Henry Holmes)
Member id
UHC-19695-21
Confidence
1
Method
probabilistic
MBR-039441CLM-414193
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003852
Orphan claim re-pointed
Claims processor
CLM-403983 → UHC-17641-18 (Sandra Price)
Member id
UHC-17641-18
Confidence
1
Method
probabilistic
MBR-001514CLM-403983
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003853
Orphan claim re-pointed
Claims processor
CLM-410112 → UHC-15032-29 (Jose Watkins)
Member id
UHC-15032-29
Confidence
1
Method
probabilistic
MBR-015663CLM-410112
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003854
Orphan claim re-pointed
Claims processor
CLM-431045 → UHC-86497-82 (Christine Sullivan)
Member id
UHC-86497-82
Confidence
1
Method
probabilistic
MBR-014703CLM-431045
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003855
Orphan claim re-pointed
Claims processor
CLM-400430 → UHC-60033-71 (Bradley Carroll)
Member id
UHC-60033-71
Confidence
1
Method
probabilistic
MBR-016939CLM-400430
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003856
Orphan claim re-pointed
Claims processor
CLM-427644 → UHC-03883-52 (Luis Wang)
Member id
UHC-03883-52
Confidence
1
Method
probabilistic
MBR-019438CLM-427644
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003857
Orphan claim re-pointed
Claims processor
CLM-404842 → UHC-27496-70 (Yuki Nguyen)
Member id
UHC-27496-70
Confidence
1
Method
probabilistic
MBR-021547CLM-404842
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003858
Orphan claim re-pointed
Claims processor
CLM-410538 → UHC-61330-54 (Adam Bailey)
Member id
UHC-61330-54
Confidence
1
Method
probabilistic
MBR-008534CLM-410538
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003859
Orphan claim re-pointed
Claims processor
CLM-403857 → UHC-86487-52 (Mei Rogers)
Member id
UHC-86487-52
Confidence
0.93
Method
probabilistic
MBR-019218CLM-403857
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003860
Orphan claim re-pointed
Claims processor
CLM-401208 → UHC-00824-54 (Ana Knight)
Member id
UHC-00824-54
Confidence
0.99
Method
probabilistic
MBR-003187CLM-401208
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003861
Orphan claim re-pointed
Claims processor
CLM-428261 → UHC-39713-31 (Bryan Perry)
Member id
UHC-39713-31
Confidence
0.98
Method
probabilistic
MBR-016229CLM-428261
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003862
Orphan claim re-pointed
Claims processor
CLM-405588 → UHC-14844-78 (Omar Richardson)
Member id
UHC-14844-78
Confidence
0.99
Method
probabilistic
MBR-009660CLM-405588
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003863
Orphan claim re-pointed
Claims processor
CLM-418689 → UHC-19774-93 (Billy Anderson)
Member id
UHC-19774-93
Confidence
1
Method
probabilistic
MBR-010692CLM-418689
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003864
Orphan claim re-pointed
Claims processor
CLM-404558 → UHC-32163-09 (Beverly Nunez)
Member id
UHC-32163-09
Confidence
0.97
Method
deterministic
MBR-042675CLM-404558
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003865
Orphan claim re-pointed
Claims processor
CLM-420622 → UHC-84264-29 (Willie Yang)
Member id
UHC-84264-29
Confidence
1
Method
probabilistic
MBR-013723CLM-420622
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003866
Orphan claim re-pointed
Claims processor
CLM-431222 → UHC-81537-62 (Donna Morris)
Member id
UHC-81537-62
Confidence
1
Method
probabilistic
MBR-016107CLM-431222
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003867
Orphan claim re-pointed
Claims processor
CLM-408238 → UHC-94226-56 (Julia Estrada)
Member id
UHC-94226-56
Confidence
0.94
Method
probabilistic
MBR-010644CLM-408238
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003868
Orphan claim re-pointed
Claims processor
CLM-422919 → UHC-53530-87 (Alexis Parker)
Member id
UHC-53530-87
Confidence
1.00
Method
probabilistic
MBR-017429CLM-422919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003869
Orphan claim re-pointed
Claims processor
CLM-428608 → UHC-63078-75 (Madison Lawson)
Member id
UHC-63078-75
Confidence
1
Method
probabilistic
MBR-027050CLM-428608
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003870
Orphan claim re-pointed
Claims processor
CLM-402711 → UHC-98906-09 (Kayla Gardner)
Member id
UHC-98906-09
Confidence
1
Method
probabilistic
MBR-036775CLM-402711
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003871
Orphan claim re-pointed
Claims processor
CLM-414319 → UHC-19095-82 (Jlie Marshall)
Member id
UHC-19095-82
Confidence
0.99
Method
probabilistic
MBR-025438CLM-414319
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003872
Orphan claim re-pointed
Claims processor
CLM-414718 → UHC-58402-80 (Brandon Fernandez)
Member id
UHC-58402-80
Confidence
1
Method
probabilistic
MBR-000266CLM-414718
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003873
Orphan claim re-pointed
Claims processor
CLM-413041 → UHC-65942-65 (Jeremy Snyder)
Member id
UHC-65942-65
Confidence
1
Method
probabilistic
MBR-031800CLM-413041
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003874
Orphan claim re-pointed
Claims processor
CLM-420447 → UHC-93836-29 (Patrick Boyd)
Member id
UHC-93836-29
Confidence
0.93
Method
probabilistic
MBR-001790CLM-420447
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003875
Orphan claim re-pointed
Claims processor
CLM-403298 → UHC-95245-95 (Vincent Hanson)
Member id
UHC-95245-95
Confidence
1
Method
probabilistic
MBR-022550CLM-403298
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003876
Orphan claim re-pointed
Claims processor
CLM-418493 → UHC-44883-09 (Alexander Porter)
Member id
UHC-44883-09
Confidence
1
Method
probabilistic
MBR-010736CLM-418493
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003877
Orphan claim re-pointed
Claims processor
CLM-403852 → UHC-60731-35 (Larry Arnold)
Member id
UHC-60731-35
Confidence
1
Method
probabilistic
MBR-009807CLM-403852
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003878
Orphan claim re-pointed
Claims processor
CLM-410411 → UHC-67569-91 (Teresa Myers)
Member id
UHC-67569-91
Confidence
1
Method
probabilistic
MBR-015023CLM-410411
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003879
Orphan claim re-pointed
Claims processor
CLM-418848 → UHC-34859-38 (Jeremy Harvey)
Member id
UHC-34859-38
Confidence
1
Method
probabilistic
MBR-033031CLM-418848
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003880
Orphan claim re-pointed
Claims processor
CLM-422507 → UHC-07710-68 (Willie Hayes)
Member id
UHC-07710-68
Confidence
1
Method
probabilistic
MBR-022557CLM-422507
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003881
Orphan claim re-pointed
Claims processor
CLM-404707 → UHC-32418-96 (Yuki Espinoza)
Member id
UHC-32418-96
Confidence
1
Method
probabilistic
MBR-012164CLM-404707
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003882
Orphan claim re-pointed
Claims processor
CLM-409792 → UHC-60029-17 (Jacqueline Webb)
Member id
UHC-60029-17
Confidence
1
Method
probabilistic
MBR-016322CLM-409792
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003883
Orphan claim re-pointed
Claims processor
CLM-421833 → UHC-36825-92 (Larry Hanson)
Member id
UHC-36825-92
Confidence
1
Method
probabilistic
MBR-013985CLM-421833
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003884
Orphan claim re-pointed
Claims processor
CLM-426323 → UHC-99703-83 (Gloria Guzman)
Member id
UHC-99703-83
Confidence
1
Method
probabilistic
MBR-005756CLM-426323
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003885
Orphan claim re-pointed
Claims processor
CLM-424554 → UHC-35421-78 (Santiago Franklin)
Member id
UHC-35421-78
Confidence
0.97
Method
deterministic
MBR-002328CLM-424554
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003886
Orphan claim re-pointed
Claims processor
CLM-416973 → UHC-42690-59 (Jose Williamson)
Member id
UHC-42690-59
Confidence
1
Method
probabilistic
MBR-007273CLM-416973
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003887
Orphan claim re-pointed
Claims processor
CLM-409768 → UHC-58917-79 (Elijah Clark)
Member id
UHC-58917-79
Confidence
1
Method
probabilistic
MBR-015550CLM-409768
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003888
Orphan claim re-pointed
Claims processor
CLM-408053 → UHC-56097-83 (Thomas Kelly)
Member id
UHC-56097-83
Confidence
1
Method
probabilistic
MBR-027083CLM-408053
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003889
Orphan claim re-pointed
Claims processor
CLM-400408 → UHC-06862-81 (Aaron Harper)
Member id
UHC-06862-81
Confidence
1
Method
probabilistic
MBR-028504CLM-400408
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 51 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.