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-004440
Orphan claim re-pointed
Claims processor
CLM-427544 → UHC-28198-68 (Marilyn George)
Member id
UHC-28198-68
Confidence
1
Method
probabilistic
MBR-020279CLM-427544
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004441
Orphan claim re-pointed
Claims processor
CLM-409764 → UHC-81594-70 (Heather Carpenter)
Member id
UHC-81594-70
Confidence
1.00
Method
probabilistic
MBR-034299CLM-409764
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004442
Orphan claim re-pointed
Claims processor
CLM-412642 → UHC-66069-07 (Olivia Sanchez)
Member id
UHC-66069-07
Confidence
1
Method
probabilistic
MBR-012318CLM-412642
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004443
Orphan claim re-pointed
Claims processor
CLM-426899 → UHC-76883-32 (Ethan Rogers)
Member id
UHC-76883-32
Confidence
1
Method
probabilistic
MBR-004933CLM-426899
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004444
Orphan claim re-pointed
Claims processor
CLM-407943 → UHC-25891-17 (Jeremy Hill)
Member id
UHC-25891-17
Confidence
0.97
Method
probabilistic
MBR-017345CLM-407943
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004445
Orphan claim re-pointed
Claims processor
CLM-420978 → UHC-04062-47 (Ronald Williamson)
Member id
UHC-04062-47
Confidence
1
Method
probabilistic
MBR-013304CLM-420978
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004446
Orphan claim re-pointed
Claims processor
CLM-404702 → UHC-03406-45 (Joseph Obrien)
Member id
UHC-03406-45
Confidence
0.99
Method
probabilistic
MBR-023190CLM-404702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004447
Orphan claim re-pointed
Claims processor
CLM-416837 → UHC-19314-17 (Terry Gomez)
Member id
UHC-19314-17
Confidence
1
Method
probabilistic
MBR-013807CLM-416837
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004448
Orphan claim re-pointed
Claims processor
CLM-428737 → UHC-38311-79 (Pamela Cooper)
Member id
UHC-38311-79
Confidence
1
Method
probabilistic
MBR-008867CLM-428737
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004449
Orphan claim re-pointed
Claims processor
CLM-401450 → UHC-43441-53 (Melissa Cruz)
Member id
UHC-43441-53
Confidence
1
Method
probabilistic
MBR-017340CLM-401450
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004450
Orphan claim re-pointed
Claims processor
CLM-413585 → UHC-05076-98 (Christian Gonzalez)
Member id
UHC-05076-98
Confidence
1
Method
probabilistic
MBR-013245CLM-413585
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004451
Orphan claim re-pointed
Claims processor
CLM-408300 → UHC-60955-24 (Michelle Jensen)
Member id
UHC-60955-24
Confidence
0.97
Method
deterministic
MBR-016856CLM-408300
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004452
Orphan claim re-pointed
Claims processor
CLM-405625 → UHC-30686-19 (Timothy Howell)
Member id
UHC-30686-19
Confidence
1
Method
probabilistic
MBR-021210CLM-405625
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004453
Orphan claim re-pointed
Claims processor
CLM-407896 → UHC-52556-86 (Dennis Hart)
Member id
UHC-52556-86
Confidence
1
Method
probabilistic
MBR-028046CLM-407896
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004454
Orphan claim re-pointed
Claims processor
CLM-424245 → UHC-43737-02 (Gabriel Freeman)
Member id
UHC-43737-02
Confidence
0.97
Method
deterministic
MBR-012474CLM-424245
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004455
Orphan claim re-pointed
Claims processor
CLM-429232 → UHC-12565-68 (Sofia Alvarez)
Member id
UHC-12565-68
Confidence
0.97
Method
deterministic
MBR-000583CLM-429232
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004456
Orphan claim re-pointed
Claims processor
CLM-425974 → UHC-38228-80 (Tyler Myres)
Member id
UHC-38228-80
Confidence
0.99
Method
probabilistic
MBR-019890CLM-425974
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004457
Orphan claim re-pointed
Claims processor
CLM-416891 → UHC-26251-27 (Natalie Shaw)
Member id
UHC-26251-27
Confidence
0.97
Method
deterministic
MBR-020218CLM-416891
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004458
Orphan claim re-pointed
Claims processor
CLM-415525 → UHC-23280-93 (Philip Garrett)
Member id
UHC-23280-93
Confidence
1
Method
probabilistic
MBR-014246CLM-415525
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004459
Orphan claim re-pointed
Claims processor
CLM-418893 → UHC-58135-07 (Gloria Franklin)
Member id
UHC-58135-07
Confidence
1
Method
probabilistic
MBR-025010CLM-418893
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004460
Orphan claim re-pointed
Claims processor
CLM-427640 → UHC-57924-01 (Shirley Simpson)
Member id
UHC-57924-01
Confidence
1
Method
probabilistic
MBR-017444CLM-427640
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004461
Orphan claim re-pointed
Claims processor
CLM-409688 → UHC-35048-99 (Aaron Taylor)
Member id
UHC-35048-99
Confidence
1
Method
probabilistic
MBR-015068CLM-409688
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004462
Orphan claim re-pointed
Claims processor
CLM-411849 → UHC-83217-83 (Denise Snyder)
Member id
UHC-83217-83
Confidence
0.86
Method
probabilistic
MBR-013388CLM-411849
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004463
Orphan claim re-pointed
Claims processor
CLM-408589 → UHC-00750-76 (Aisha Garza)
Member id
UHC-00750-76
Confidence
1
Method
probabilistic
MBR-026432CLM-408589
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004464
Orphan claim re-pointed
Claims processor
CLM-430305 → UHC-48651-30 (Mariana Gordon)
Member id
UHC-48651-30
Confidence
1
Method
probabilistic
MBR-007032CLM-430305
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004465
Orphan claim re-pointed
Claims processor
CLM-427314 → UHC-10806-16 (Sharon Rodriguez)
Member id
UHC-10806-16
Confidence
0.85
Method
probabilistic
MBR-042107CLM-427314
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004466
Orphan claim re-pointed
Claims processor
CLM-404700 → UHC-03406-45 (Joseph Obrien)
Member id
UHC-03406-45
Confidence
0.99
Method
probabilistic
MBR-023190CLM-404700
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004467
Orphan claim re-pointed
Claims processor
CLM-411659 → UHC-43847-07 (Lisa Sanchez)
Member id
UHC-43847-07
Confidence
0.99
Method
probabilistic
MBR-018703CLM-411659
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004468
Orphan claim re-pointed
Claims processor
CLM-402142 → UHC-32734-85 (Bruce Johnston)
Member id
UHC-32734-85
Confidence
0.97
Method
deterministic
MBR-008126CLM-402142
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004469
Orphan claim re-pointed
Claims processor
CLM-409024 → UHC-02353-12 (Ray Pierce)
Member id
UHC-02353-12
Confidence
1
Method
probabilistic
MBR-010231CLM-409024
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004470
Orphan claim re-pointed
Claims processor
CLM-417206 → UHC-13928-11 (Sarah Reed)
Member id
UHC-13928-11
Confidence
0.97
Method
deterministic
MBR-021703CLM-417206
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004471
Orphan claim re-pointed
Claims processor
CLM-413074 → UHC-81599-10 (Theresa Parker)
Member id
UHC-81599-10
Confidence
0.99
Method
probabilistic
MBR-034749CLM-413074
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004472
Orphan claim re-pointed
Claims processor
CLM-423359 → UHC-80053-21 (Billy Fisher)
Member id
UHC-80053-21
Confidence
1
Method
probabilistic
MBR-013323CLM-423359
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004473
Orphan claim re-pointed
Claims processor
CLM-431527 → UHC-20779-93 (Amanda Kim)
Member id
UHC-20779-93
Confidence
1
Method
probabilistic
MBR-038875CLM-431527
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004474
Orphan claim re-pointed
Claims processor
CLM-409564 → UHC-09486-83 (Carolyn Berry)
Member id
UHC-09486-83
Confidence
1
Method
probabilistic
MBR-025821CLM-409564
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004475
Orphan claim re-pointed
Claims processor
CLM-425673 → UHC-63043-32 (Evelyn Morrison)
Member id
UHC-63043-32
Confidence
1
Method
probabilistic
MBR-001171CLM-425673
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004476
Orphan claim re-pointed
Claims processor
CLM-417467 → UHC-67117-89 (Alice Harper)
Member id
UHC-67117-89
Confidence
0.93
Method
probabilistic
MBR-001612CLM-417467
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004477
Orphan claim re-pointed
Claims processor
CLM-404454 → UHC-92470-78 (Larry Martin)
Member id
UHC-92470-78
Confidence
1
Method
probabilistic
MBR-002466CLM-404454
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004478
Orphan claim re-pointed
Claims processor
CLM-401033 → UHC-90615-72 (Zachary Stune)
Member id
UHC-90615-72
Confidence
0.98
Method
probabilistic
MBR-005689CLM-401033
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004479
Orphan claim re-pointed
Claims processor
CLM-408296 → UHC-34471-48 (Teresa Edwards)
Member id
UHC-34471-48
Confidence
1
Method
probabilistic
MBR-013072CLM-408296
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004480
Orphan claim re-pointed
Claims processor
CLM-412936 → UHC-93843-37 (Carl Lewis)
Member id
UHC-93843-37
Confidence
1
Method
probabilistic
MBR-039725CLM-412936
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004481
Orphan claim re-pointed
Claims processor
CLM-410016 → UHC-48577-49 (Noah Estrada)
Member id
UHC-48577-49
Confidence
0.97
Method
deterministic
MBR-002955CLM-410016
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004482
Orphan claim re-pointed
Claims processor
CLM-417828 → UHC-66935-98 (Ashley Bradley)
Member id
UHC-66935-98
Confidence
1
Method
probabilistic
MBR-000890CLM-417828
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004483
Orphan claim re-pointed
Claims processor
CLM-421609 → UHC-45344-03 (Peter Ford)
Member id
UHC-45344-03
Confidence
0.97
Method
deterministic
MBR-009536CLM-421609
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004484
Orphan claim re-pointed
Claims processor
CLM-417967 → UHC-22549-45 (Jack Dunn)
Member id
UHC-22549-45
Confidence
0.97
Method
probabilistic
MBR-009019CLM-417967
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004485
Orphan claim re-pointed
Claims processor
CLM-407901 → UHC-47589-10 (Bradley Robinson)
Member id
UHC-47589-10
Confidence
0.97
Method
deterministic
MBR-030116CLM-407901
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004486
Orphan claim re-pointed
Claims processor
CLM-415316 → UHC-06212-17 (Sara Scott)
Member id
UHC-06212-17
Confidence
1
Method
probabilistic
MBR-002921CLM-415316
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004487
Orphan claim re-pointed
Claims processor
CLM-427192 → UHC-75188-27 (Carol Murray)
Member id
UHC-75188-27
Confidence
1
Method
probabilistic
MBR-030470CLM-427192
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004488
Orphan claim re-pointed
Claims processor
CLM-409566 → UHC-98542-11 (Jessica Bennett)
Member id
UHC-98542-11
Confidence
1
Method
probabilistic
MBR-012341CLM-409566
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004489
Orphan claim re-pointed
Claims processor
CLM-430232 → UHC-73394-99 (Carol Olson)
Member id
UHC-73394-99
Confidence
0.98
Method
probabilistic
MBR-016766CLM-430232
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 63 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.