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-005040
Orphan claim re-pointed
Claims processor
CLM-426873 → UHC-73065-25 (Joseph Berry)
Member id
UHC-73065-25
Confidence
1
Method
probabilistic
MBR-023363CLM-426873
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005041
Orphan claim re-pointed
Claims processor
CLM-401576 → UHC-07883-92 (Noah Le)
Member id
UHC-07883-92
Confidence
0.97
Method
deterministic
MBR-001891CLM-401576
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005042
Orphan claim re-pointed
Claims processor
CLM-402361 → UHC-35872-51 (Cheryl Henry)
Member id
UHC-35872-51
Confidence
1
Method
probabilistic
MBR-026501CLM-402361
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005043
Orphan claim re-pointed
Claims processor
CLM-409996 → UHC-18308-01 (Charlotte Larson)
Member id
UHC-18308-01
Confidence
0.99
Method
probabilistic
MBR-004341CLM-409996
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005044
Orphan claim re-pointed
Claims processor
CLM-425186 → UHC-62292-14 (Ann Holmes)
Member id
UHC-62292-14
Confidence
1
Method
probabilistic
MBR-023245CLM-425186
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005045
Orphan claim re-pointed
Claims processor
CLM-417487 → UHC-12071-81 (Rebecca Hernandez)
Member id
UHC-12071-81
Confidence
0.97
Method
deterministic
MBR-037984CLM-417487
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005046
Orphan claim re-pointed
Claims processor
CLM-420656 → UHC-32056-09 (Cheryl Rose)
Member id
UHC-32056-09
Confidence
1
Method
probabilistic
MBR-028248CLM-420656
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005047
Orphan claim re-pointed
Claims processor
CLM-416356 → UHC-58967-66 (Brittany Sandoval)
Member id
UHC-58967-66
Confidence
1
Method
probabilistic
MBR-034301CLM-416356
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005048
Orphan claim re-pointed
Claims processor
CLM-421508 → UHC-40709-05 (Angla Burns)
Member id
UHC-40709-05
Confidence
1
Method
probabilistic
MBR-005336CLM-421508
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005049
Orphan claim re-pointed
Claims processor
CLM-409818 → UHC-62109-92 (Arthur Spencer)
Member id
UHC-62109-92
Confidence
1
Method
probabilistic
MBR-002878CLM-409818
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005050
Orphan claim re-pointed
Claims processor
CLM-409370 → UHC-09097-49 (Gerald Ramirez)
Member id
UHC-09097-49
Confidence
0.99
Method
probabilistic
MBR-004120CLM-409370
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005051
Orphan claim re-pointed
Claims processor
CLM-429680 → UHC-93915-47 (Barbara Owens)
Member id
UHC-93915-47
Confidence
1
Method
probabilistic
MBR-009932CLM-429680
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005052
Orphan claim re-pointed
Claims processor
CLM-430299 → UHC-82830-37 (Karen Bailey)
Member id
UHC-82830-37
Confidence
1
Method
probabilistic
MBR-000994CLM-430299
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005053
Orphan claim re-pointed
Claims processor
CLM-412580 → UHC-11667-88 (Shirley Sanchez)
Member id
UHC-11667-88
Confidence
1
Method
probabilistic
MBR-012117CLM-412580
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005054
Orphan claim re-pointed
Claims processor
CLM-406661 → UHC-43546-14 (Brandon Allen)
Member id
UHC-43546-14
Confidence
0.97
Method
deterministic
MBR-004478CLM-406661
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005055
Orphan claim re-pointed
Claims processor
CLM-410911 → UHC-73134-47 (Russell Gutierrez)
Member id
UHC-73134-47
Confidence
1
Method
probabilistic
MBR-012852CLM-410911
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005056
Orphan claim re-pointed
Claims processor
CLM-419656 → UHC-70900-77 (Samuel Fields)
Member id
UHC-70900-77
Confidence
1
Method
probabilistic
MBR-013967CLM-419656
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005057
Orphan claim re-pointed
Claims processor
CLM-429644 → UHC-12728-30 (Joshua Campbell)
Member id
UHC-12728-30
Confidence
1
Method
probabilistic
MBR-004368CLM-429644
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005058
Orphan claim re-pointed
Claims processor
CLM-430736 → UHC-59470-91 (Brenda Grant)
Member id
UHC-59470-91
Confidence
1
Method
probabilistic
MBR-012618CLM-430736
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005059
Orphan claim re-pointed
Claims processor
CLM-416330 → UHC-89496-41 (Arthur Wagner)
Member id
UHC-89496-41
Confidence
1
Method
probabilistic
MBR-002559CLM-416330
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005060
Orphan claim re-pointed
Claims processor
CLM-411202 → UHC-46808-96 (Gabriel Castillo)
Member id
UHC-46808-96
Confidence
1
Method
probabilistic
MBR-016589CLM-411202
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005061
Orphan claim re-pointed
Claims processor
CLM-425474 → UHC-33599-32 (Sean Young)
Member id
UHC-33599-32
Confidence
0.97
Method
deterministic
MBR-024788CLM-425474
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005062
Orphan claim re-pointed
Claims processor
CLM-400831 → UHC-00120-23 (Hannah Burke)
Member id
UHC-00120-23
Confidence
1
Method
probabilistic
MBR-015128CLM-400831
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005063
Orphan claim re-pointed
Claims processor
CLM-429967 → UHC-31923-24 (Shirley Fisher)
Member id
UHC-31923-24
Confidence
1
Method
probabilistic
MBR-031224CLM-429967
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005064
Orphan claim re-pointed
Claims processor
CLM-426229 → UHC-72872-02 (Samantha Morris)
Member id
UHC-72872-02
Confidence
0.93
Method
probabilistic
MBR-019686CLM-426229
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005065
Orphan claim re-pointed
Claims processor
CLM-422385 → UHC-97031-33 (Teresa Gonzales)
Member id
UHC-97031-33
Confidence
1
Method
probabilistic
MBR-004871CLM-422385
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005066
Orphan claim re-pointed
Claims processor
CLM-401699 → UHC-66628-01 (Bryan Wang)
Member id
UHC-66628-01
Confidence
1
Method
probabilistic
MBR-009122CLM-401699
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005067
Orphan claim re-pointed
Claims processor
CLM-430915 → UHC-43468-04 (Justin Le)
Member id
UHC-43468-04
Confidence
1
Method
probabilistic
MBR-003225CLM-430915
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005068
Orphan claim re-pointed
Claims processor
CLM-412139 → UHC-45255-44 (Julie Nelson)
Member id
UHC-45255-44
Confidence
1
Method
probabilistic
MBR-034592CLM-412139
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005069
Orphan claim re-pointed
Claims processor
CLM-424574 → UHC-98151-65 (Gary Knight)
Member id
UHC-98151-65
Confidence
0.94
Method
probabilistic
MBR-000224CLM-424574
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005070
Orphan claim re-pointed
Claims processor
CLM-406369 → UHC-10686-47 (Carlos Austin)
Member id
UHC-10686-47
Confidence
1
Method
probabilistic
MBR-029976CLM-406369
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005071
Orphan claim re-pointed
Claims processor
CLM-426796 → UHC-34909-33 (Elijah Montgomery)
Member id
UHC-34909-33
Confidence
1.00
Method
probabilistic
MBR-011870CLM-426796
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005072
Orphan claim re-pointed
Claims processor
CLM-402988 → UHC-52113-23 (Joan Mason)
Member id
UHC-52113-23
Confidence
0.97
Method
deterministic
MBR-008141CLM-402988
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005073
Orphan claim re-pointed
Claims processor
CLM-431172 → UHC-77933-88 (Zachary Adams)
Member id
UHC-77933-88
Confidence
0.99
Method
probabilistic
MBR-005773CLM-431172
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005074
Orphan claim re-pointed
Claims processor
CLM-403098 → UHC-60388-12 (Samantha Jensen)
Member id
UHC-60388-12
Confidence
1
Method
probabilistic
MBR-006766CLM-403098
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005075
Orphan claim re-pointed
Claims processor
CLM-402741 → UHC-37593-70 (Emily Roberts)
Member id
UHC-37593-70
Confidence
1
Method
probabilistic
MBR-011793CLM-402741
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005076
Orphan claim re-pointed
Claims processor
CLM-400255 → UHC-93581-67 (Marcus Garcia)
Member id
UHC-93581-67
Confidence
0.99
Method
probabilistic
MBR-009027CLM-400255
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005077
Orphan claim re-pointed
Claims processor
CLM-423924 → UHC-34181-47 (Marcus Fuller)
Member id
UHC-34181-47
Confidence
1
Method
probabilistic
MBR-004491CLM-423924
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005078
Orphan claim re-pointed
Claims processor
CLM-424140 → UHC-07458-97 (Sofia Walker)
Member id
UHC-07458-97
Confidence
0.97
Method
deterministic
MBR-002935CLM-424140
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005079
Orphan claim re-pointed
Claims processor
CLM-424893 → UHC-79675-76 (Carl Campbell)
Member id
UHC-79675-76
Confidence
1
Method
probabilistic
MBR-015484CLM-424893
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005080
Orphan claim re-pointed
Claims processor
CLM-426327 → UHC-26756-01 (Frank Fernandez)
Member id
UHC-26756-01
Confidence
1
Method
probabilistic
MBR-024771CLM-426327
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005081
Orphan claim re-pointed
Claims processor
CLM-431776 → UHC-44013-32 (Megan Moore)
Member id
UHC-44013-32
Confidence
0.97
Method
deterministic
MBR-029432CLM-431776
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005082
Orphan claim re-pointed
Claims processor
CLM-407980 → UHC-72876-61 (Ralph Gray)
Member id
UHC-72876-61
Confidence
0.97
Method
probabilistic
MBR-009289CLM-407980
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005083
Orphan claim re-pointed
Claims processor
CLM-411277 → UHC-94025-69 (Frank Lawrence)
Member id
UHC-94025-69
Confidence
0.97
Method
deterministic
MBR-011254CLM-411277
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005084
Orphan claim re-pointed
Claims processor
CLM-428302 → UHC-96291-49 (Jonathan Kennedy)
Member id
UHC-96291-49
Confidence
1
Method
probabilistic
MBR-017459CLM-428302
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005085
Orphan claim re-pointed
Claims processor
CLM-413986 → UHC-53015-02 (Kimberly Jones)
Member id
UHC-53015-02
Confidence
0.97
Method
deterministic
MBR-017361CLM-413986
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005086
Orphan claim re-pointed
Claims processor
CLM-417177 → UHC-25263-97 (Brian Elliott)
Member id
UHC-25263-97
Confidence
0.97
Method
deterministic
MBR-004856CLM-417177
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005087
Orphan claim re-pointed
Claims processor
CLM-405297 → UHC-25905-92 (Austin Williams)
Member id
UHC-25905-92
Confidence
0.97
Method
deterministic
MBR-030854CLM-405297
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005088
Orphan claim re-pointed
Claims processor
CLM-428605 → UHC-14029-74 (Kathleen Carr)
Member id
UHC-14029-74
Confidence
1
Method
probabilistic
MBR-006388CLM-428605
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005089
Orphan claim re-pointed
Claims processor
CLM-413517 → UHC-65690-96 (Betsy Perez)
Member id
UHC-65690-96
Confidence
0.97
Method
deterministic
MBR-034384CLM-413517
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 75 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.