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-005590
Orphan claim re-pointed
Claims processor
CLM-428684 → UHC-74418-07 (Maria Perez)
Member id
UHC-74418-07
Confidence
0.97
Method
deterministic
MBR-009917CLM-428684
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005591
Orphan claim re-pointed
Claims processor
CLM-432086 → UHC-74349-97 (Arthur Wilson)
Member id
UHC-74349-97
Confidence
1
Method
probabilistic
MBR-022966CLM-432086
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005592
Orphan claim re-pointed
Claims processor
CLM-400919 → UHC-61532-06 (Catherine Hoffman)
Member id
UHC-61532-06
Confidence
1
Method
probabilistic
MBR-018829CLM-400919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005593
Orphan claim re-pointed
Claims processor
CLM-410914 → UHC-70981-11 (Diana Chapman)
Member id
UHC-70981-11
Confidence
1
Method
probabilistic
MBR-021218CLM-410914
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005594
Orphan claim re-pointed
Claims processor
CLM-427436 → UHC-79164-92 (Julie Garrett)
Member id
UHC-79164-92
Confidence
1
Method
probabilistic
MBR-022053CLM-427436
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005595
Orphan claim re-pointed
Claims processor
CLM-408309 → UHC-92954-99 (Christine Brown)
Member id
UHC-92954-99
Confidence
1
Method
probabilistic
MBR-001194CLM-408309
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005596
Orphan claim re-pointed
Claims processor
CLM-415213 → UHC-11141-74 (Lucia Holmes)
Member id
UHC-11141-74
Confidence
1
Method
probabilistic
MBR-019290CLM-415213
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005597
Orphan claim re-pointed
Claims processor
CLM-415576 → UHC-18628-86 (Barbara Fisher)
Member id
UHC-18628-86
Confidence
1
Method
probabilistic
MBR-003325CLM-415576
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005598
Orphan claim re-pointed
Claims processor
CLM-400914 → UHC-81585-75 (Gloria Dunn)
Member id
UHC-81585-75
Confidence
1
Method
probabilistic
MBR-032589CLM-400914
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005599
Orphan claim re-pointed
Claims processor
CLM-403884 → UHC-94244-68 (Keith Jordan)
Member id
UHC-94244-68
Confidence
0.97
Method
deterministic
MBR-006415CLM-403884
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005600
Orphan claim re-pointed
Claims processor
CLM-429534 → UHC-79482-59 (Betty Murray)
Member id
UHC-79482-59
Confidence
1
Method
probabilistic
MBR-016198CLM-429534
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005601
Orphan claim re-pointed
Claims processor
CLM-407992 → UHC-31120-14 (Samantha Nunez)
Member id
UHC-31120-14
Confidence
1
Method
probabilistic
MBR-008099CLM-407992
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005602
Orphan claim re-pointed
Claims processor
CLM-431014 → UHC-39944-48 (Omar James)
Member id
UHC-39944-48
Confidence
1
Method
probabilistic
MBR-024434CLM-431014
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005603
Orphan claim re-pointed
Claims processor
CLM-428715 → UHC-71567-41 (Frances Spencer)
Member id
UHC-71567-41
Confidence
0.97
Method
deterministic
MBR-030408CLM-428715
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005604
Orphan claim re-pointed
Claims processor
CLM-422916 → UHC-41100-42 (Justin Hamilton)
Member id
UHC-41100-42
Confidence
1
Method
probabilistic
MBR-023549CLM-422916
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005605
Orphan claim re-pointed
Claims processor
CLM-426911 → UHC-92801-47 (Susan Morrison)
Member id
UHC-92801-47
Confidence
0.97
Method
deterministic
MBR-026560CLM-426911
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005606
Orphan claim re-pointed
Claims processor
CLM-418550 → UHC-73379-98 (Russell Powell)
Member id
UHC-73379-98
Confidence
1
Method
probabilistic
MBR-004017CLM-418550
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005607
Orphan claim re-pointed
Claims processor
CLM-419431 → UHC-87437-98 (Christine Stevens)
Member id
UHC-87437-98
Confidence
1
Method
probabilistic
MBR-020918CLM-419431
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005608
Orphan claim re-pointed
Claims processor
CLM-423240 → UHC-15009-91 (Jackie Diaz)
Member id
UHC-15009-91
Confidence
1
Method
probabilistic
MBR-022650CLM-423240
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005609
Orphan claim re-pointed
Claims processor
CLM-412005 → UHC-57532-94 (Julia Cook)
Member id
UHC-57532-94
Confidence
1
Method
probabilistic
MBR-005790CLM-412005
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005610
Orphan claim re-pointed
Claims processor
CLM-418549 → UHC-73379-98 (Russell Powell)
Member id
UHC-73379-98
Confidence
0.99
Method
probabilistic
MBR-004017CLM-418549
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005611
Orphan claim re-pointed
Claims processor
CLM-426380 → UHC-73892-28 (Anna Boyd)
Member id
UHC-73892-28
Confidence
0.92
Method
probabilistic
MBR-025736CLM-426380
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005612
Orphan claim re-pointed
Claims processor
CLM-418029 → UHC-76486-86 (Katherine Walker)
Member id
UHC-76486-86
Confidence
0.98
Method
probabilistic
MBR-018498CLM-418029
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005613
Orphan claim re-pointed
Claims processor
CLM-422344 → UHC-22273-83 (Martha Dixon)
Member id
UHC-22273-83
Confidence
1
Method
probabilistic
MBR-011803CLM-422344
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005614
Orphan claim re-pointed
Claims processor
CLM-410710 → UHC-96663-83 (Evelyn Williams)
Member id
UHC-96663-83
Confidence
1
Method
probabilistic
MBR-010533CLM-410710
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005615
Orphan claim re-pointed
Claims processor
CLM-402623 → UHC-18828-56 (Luis Vega)
Member id
UHC-18828-56
Confidence
1
Method
probabilistic
MBR-017929CLM-402623
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005616
Orphan claim re-pointed
Claims processor
CLM-430051 → UHC-89611-35 (Gary Chapman)
Member id
UHC-89611-35
Confidence
1
Method
probabilistic
MBR-042539CLM-430051
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005617
Orphan claim re-pointed
Claims processor
CLM-416166 → UHC-35992-83 (Tyler Rose)
Member id
UHC-35992-83
Confidence
1
Method
probabilistic
MBR-010168CLM-416166
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005618
Orphan claim re-pointed
Claims processor
CLM-429284 → UHC-41583-48 (Vincent Ramirez)
Member id
UHC-41583-48
Confidence
1
Method
probabilistic
MBR-007777CLM-429284
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005619
Orphan claim re-pointed
Claims processor
CLM-407074 → UHC-47771-45 (Angela Sanders)
Member id
UHC-47771-45
Confidence
1
Method
probabilistic
MBR-006760CLM-407074
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005620
Orphan claim re-pointed
Claims processor
CLM-416569 → UHC-54398-04 (Julia Hansen)
Member id
UHC-54398-04
Confidence
1
Method
probabilistic
MBR-023998CLM-416569
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005621
Orphan claim re-pointed
Claims processor
CLM-428519 → UHC-35911-04 (Carolyn Log)
Member id
UHC-35911-04
Confidence
0.98
Method
probabilistic
MBR-023875CLM-428519
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005622
Orphan claim re-pointed
Claims processor
CLM-412389 → UHC-11519-51 (Linda Perkins)
Member id
UHC-11519-51
Confidence
1
Method
probabilistic
MBR-033623CLM-412389
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005623
Orphan claim re-pointed
Claims processor
CLM-416482 → UHC-72382-09 (Arthur Guzman)
Member id
UHC-72382-09
Confidence
1
Method
probabilistic
MBR-012434CLM-416482
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005624
Orphan claim re-pointed
Claims processor
CLM-417805 → UHC-54869-17 (Sean Wright)
Member id
UHC-54869-17
Confidence
1
Method
probabilistic
MBR-001876CLM-417805
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005625
Orphan claim re-pointed
Claims processor
CLM-403823 → UHC-84890-95 (Gerald Miller)
Member id
UHC-84890-95
Confidence
0.99
Method
probabilistic
MBR-001149CLM-403823
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005626
Orphan claim re-pointed
Claims processor
CLM-404097 → UHC-08426-20 (Alexander Berry)
Member id
UHC-08426-20
Confidence
1
Method
probabilistic
MBR-023067CLM-404097
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005627
Orphan claim re-pointed
Claims processor
CLM-405703 → UHC-77190-83 (Abigail Little)
Member id
UHC-77190-83
Confidence
1
Method
probabilistic
MBR-019965CLM-405703
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005628
Orphan claim re-pointed
Claims processor
CLM-407478 → UHC-91231-49 (Andrew Contreras)
Member id
UHC-91231-49
Confidence
1
Method
probabilistic
MBR-033039CLM-407478
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005629
Orphan claim re-pointed
Claims processor
CLM-402605 → UHC-15944-44 (Frances Pierce)
Member id
UHC-15944-44
Confidence
1
Method
probabilistic
MBR-010936CLM-402605
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005630
Orphan claim re-pointed
Claims processor
CLM-403239 → UHC-56934-35 (Valentina Duncan)
Member id
UHC-56934-35
Confidence
0.98
Method
probabilistic
MBR-022070CLM-403239
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005631
Orphan claim re-pointed
Claims processor
CLM-424597 → UHC-57735-93 (Jerry Perkins)
Member id
UHC-57735-93
Confidence
1
Method
probabilistic
MBR-029598CLM-424597
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005632
Orphan claim re-pointed
Claims processor
CLM-429666 → UHC-33762-69 (Jack Robertson)
Member id
UHC-33762-69
Confidence
1
Method
probabilistic
MBR-040710CLM-429666
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005633
Orphan claim re-pointed
Claims processor
CLM-407260 → UHC-44419-60 (Lucia Woods)
Member id
UHC-44419-60
Confidence
1
Method
probabilistic
MBR-018410CLM-407260
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005634
Orphan claim re-pointed
Claims processor
CLM-421539 → UHC-53327-52 (Frances Ruiz)
Member id
UHC-53327-52
Confidence
0.94
Method
probabilistic
MBR-005179CLM-421539
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005635
Orphan claim re-pointed
Claims processor
CLM-400070 → UHC-31236-97 (Amber Wells)
Member id
UHC-31236-97
Confidence
0.97
Method
deterministic
MBR-032224CLM-400070
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005636
Orphan claim re-pointed
Claims processor
CLM-410442 → UHC-84531-10 (Amy Yang)
Member id
UHC-84531-10
Confidence
1
Method
probabilistic
MBR-043661CLM-410442
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005637
Orphan claim re-pointed
Claims processor
CLM-408344 → UHC-58073-33 (Alexander Perez)
Member id
UHC-58073-33
Confidence
1
Method
probabilistic
MBR-031568CLM-408344
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005638
Orphan claim re-pointed
Claims processor
CLM-411892 → UHC-60653-85 (Ryan Fuller)
Member id
UHC-60653-85
Confidence
0.97
Method
deterministic
MBR-016758CLM-411892
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005639
Orphan claim re-pointed
Claims processor
CLM-419065 → UHC-32667-67 (Emma Ortiz)
Member id
UHC-32667-67
Confidence
1
Method
probabilistic
MBR-012322CLM-419065
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 86 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.