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-005790
Orphan claim re-pointed
Claims processor
CLM-431323 → UHC-46514-85 (Jack Jordan)
Member id
UHC-46514-85
Confidence
0.91
Method
probabilistic
MBR-013408CLM-431323
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005791
Orphan claim re-pointed
Claims processor
CLM-409571 → UHC-33464-88 (Harold Mason)
Member id
UHC-33464-88
Confidence
1
Method
probabilistic
MBR-003623CLM-409571
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005792
Orphan claim re-pointed
Claims processor
CLM-412431 → UHC-41836-57 (Willie Hansen)
Member id
UHC-41836-57
Confidence
1
Method
probabilistic
MBR-029465CLM-412431
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005793
Orphan claim re-pointed
Claims processor
CLM-403611 → UHC-10594-91 (Joseph Cunningham)
Member id
UHC-10594-91
Confidence
1
Method
probabilistic
MBR-009256CLM-403611
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005794
Orphan claim re-pointed
Claims processor
CLM-416142 → UHC-61680-99 (Karen Cook)
Member id
UHC-61680-99
Confidence
1
Method
probabilistic
MBR-006874CLM-416142
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005795
Orphan claim re-pointed
Claims processor
CLM-400237 → UHC-96990-15 (Angela Espinoza)
Member id
UHC-96990-15
Confidence
0.99
Method
probabilistic
MBR-017663CLM-400237
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005796
Orphan claim re-pointed
Claims processor
CLM-425893 → UHC-32653-89 (Maria Freeman)
Member id
UHC-32653-89
Confidence
1
Method
probabilistic
MBR-000706CLM-425893
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005797
Orphan claim re-pointed
Claims processor
CLM-425717 → UHC-20504-81 (Teresa Fisher)
Member id
UHC-20504-81
Confidence
0.99
Method
probabilistic
MBR-009576CLM-425717
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005798
Orphan claim re-pointed
Claims processor
CLM-427378 → UHC-30457-09 (Roger Davis)
Member id
UHC-30457-09
Confidence
1
Method
probabilistic
MBR-010102CLM-427378
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005799
Orphan claim re-pointed
Claims processor
CLM-405041 → UHC-78535-38 (Judy Sanders)
Member id
UHC-78535-38
Confidence
1
Method
probabilistic
MBR-024997CLM-405041
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005800
Orphan claim re-pointed
Claims processor
CLM-401206 → UHC-20620-59 (Katherine Carpenter)
Member id
UHC-20620-59
Confidence
1
Method
probabilistic
MBR-006438CLM-401206
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005801
Orphan claim re-pointed
Claims processor
CLM-407617 → UHC-79313-90 (Patricia Schultz)
Member id
UHC-79313-90
Confidence
1
Method
probabilistic
MBR-025847CLM-407617
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005802
Orphan claim re-pointed
Claims processor
CLM-412968 → UHC-20449-42 (Janice Hunt)
Member id
UHC-20449-42
Confidence
1
Method
probabilistic
MBR-021671CLM-412968
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005803
Orphan claim re-pointed
Claims processor
CLM-401425 → UHC-69979-70 (Maria Singh)
Member id
UHC-69979-70
Confidence
0.98
Method
probabilistic
MBR-018695CLM-401425
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005804
Orphan claim re-pointed
Claims processor
CLM-410430 → UHC-36655-13 (Anna Dunn)
Member id
UHC-36655-13
Confidence
1
Method
probabilistic
MBR-015284CLM-410430
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005805
Orphan claim re-pointed
Claims processor
CLM-429432 → UHC-83381-43 (Mason Taylor)
Member id
UHC-83381-43
Confidence
1
Method
probabilistic
MBR-019125CLM-429432
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005806
Orphan claim re-pointed
Claims processor
CLM-419003 → UHC-78943-88 (Rachel Green)
Member id
UHC-78943-88
Confidence
0.97
Method
deterministic
MBR-025662CLM-419003
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005807
Orphan claim re-pointed
Claims processor
CLM-426478 → UHC-23750-61 (Bryan Matthews)
Member id
UHC-23750-61
Confidence
1
Method
probabilistic
MBR-017637CLM-426478
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005808
Orphan claim re-pointed
Claims processor
CLM-411775 → UHC-64477-90 (Eric Elliott)
Member id
UHC-64477-90
Confidence
1
Method
probabilistic
MBR-004617CLM-411775
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005809
Orphan claim re-pointed
Claims processor
CLM-402188 → UHC-07177-15 (Theresa West)
Member id
UHC-07177-15
Confidence
0.97
Method
deterministic
MBR-003519CLM-402188
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005810
Orphan claim re-pointed
Claims processor
CLM-404895 → UHC-67650-36 (Wei Harrison)
Member id
UHC-67650-36
Confidence
1
Method
probabilistic
MBR-014493CLM-404895
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005811
Orphan claim re-pointed
Claims processor
CLM-419704 → UHC-19883-88 (Gabriel Thompson)
Member id
UHC-19883-88
Confidence
1
Method
probabilistic
MBR-010009CLM-419704
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005812
Orphan claim re-pointed
Claims processor
CLM-423458 → UHC-15734-55 (Patricia Cooper)
Member id
UHC-15734-55
Confidence
1
Method
probabilistic
MBR-007189CLM-423458
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005813
Orphan claim re-pointed
Claims processor
CLM-423803 → UHC-46530-32 (Frank Parker)
Member id
UHC-46530-32
Confidence
0.92
Method
probabilistic
MBR-017919CLM-423803
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005814
Orphan claim re-pointed
Claims processor
CLM-401267 → UHC-49602-83 (Diego Woods)
Member id
UHC-49602-83
Confidence
1
Method
probabilistic
MBR-027391CLM-401267
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005815
Orphan claim re-pointed
Claims processor
CLM-404824 → UHC-23811-98 (Heather Myers)
Member id
UHC-23811-98
Confidence
1
Method
probabilistic
MBR-008860CLM-404824
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005816
Orphan claim re-pointed
Claims processor
CLM-421054 → UHC-98893-34 (Dennis Sims)
Member id
UHC-98893-34
Confidence
1
Method
probabilistic
MBR-015754CLM-421054
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005817
Orphan claim re-pointed
Claims processor
CLM-416338 → UHC-88907-28 (Albert Daniels)
Member id
UHC-88907-28
Confidence
1
Method
probabilistic
MBR-016082CLM-416338
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005818
Orphan claim re-pointed
Claims processor
CLM-425167 → UHC-83435-92 (Randy Jensen)
Member id
UHC-83435-92
Confidence
0.97
Method
deterministic
MBR-033489CLM-425167
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005819
Orphan claim re-pointed
Claims processor
CLM-424062 → UHC-10104-58 (Luis Jones)
Member id
UHC-10104-58
Confidence
0.97
Method
deterministic
MBR-022603CLM-424062
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005820
Orphan claim re-pointed
Claims processor
CLM-405498 → UHC-12383-43 (Ahmed Bailey)
Member id
UHC-12383-43
Confidence
1
Method
probabilistic
MBR-019730CLM-405498
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005821
Orphan claim re-pointed
Claims processor
CLM-416444 → UHC-65456-50 (Janice Ramos)
Member id
UHC-65456-50
Confidence
1
Method
probabilistic
MBR-011714CLM-416444
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005822
Orphan claim re-pointed
Claims processor
CLM-403334 → UHC-94792-89 (Janice Harper)
Member id
UHC-94792-89
Confidence
0.97
Method
deterministic
MBR-024163CLM-403334
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005823
Orphan claim re-pointed
Claims processor
CLM-427416 → UHC-09454-42 (Karen Fowler)
Member id
UHC-09454-42
Confidence
1
Method
probabilistic
MBR-002592CLM-427416
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005824
Orphan claim re-pointed
Claims processor
CLM-425161 → UHC-75033-63 (Joseph Bell)
Member id
UHC-75033-63
Confidence
1
Method
probabilistic
MBR-009201CLM-425161
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005825
Orphan claim re-pointed
Claims processor
CLM-409536 → UHC-14006-97 (Arjun Walsh)
Member id
UHC-14006-97
Confidence
1
Method
probabilistic
MBR-033129CLM-409536
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005826
Orphan claim re-pointed
Claims processor
CLM-400190 → UHC-85133-36 (Jean Torres)
Member id
UHC-85133-36
Confidence
1
Method
probabilistic
MBR-012932CLM-400190
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005827
Orphan claim re-pointed
Claims processor
CLM-406899 → UHC-41769-76 (Barbara Hanson)
Member id
UHC-41769-76
Confidence
0.99
Method
probabilistic
MBR-009642CLM-406899
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005828
Orphan claim re-pointed
Claims processor
CLM-420643 → UHC-67055-10 (Sarah Schmidt)
Member id
UHC-67055-10
Confidence
0.98
Method
probabilistic
MBR-031471CLM-420643
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005829
Orphan claim re-pointed
Claims processor
CLM-411294 → UHC-38480-02 (Kathryn Ross)
Member id
UHC-38480-02
Confidence
0.97
Method
deterministic
MBR-024800CLM-411294
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005830
Orphan claim re-pointed
Claims processor
CLM-404940 → UHC-23727-64 (Zachary Ortega)
Member id
UHC-23727-64
Confidence
0.99
Method
probabilistic
MBR-016485CLM-404940
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005831
Orphan claim re-pointed
Claims processor
CLM-407138 → UHC-72667-92 (Jason Tucker)
Member id
UHC-72667-92
Confidence
1
Method
probabilistic
MBR-010429CLM-407138
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005832
Orphan claim re-pointed
Claims processor
CLM-419583 → UHC-23309-57 (Jesse Harrison)
Member id
UHC-23309-57
Confidence
1
Method
probabilistic
MBR-010825CLM-419583
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005833
Orphan claim re-pointed
Claims processor
CLM-426884 → UHC-10651-17 (Doris Bradley)
Member id
UHC-10651-17
Confidence
1
Method
probabilistic
MBR-025251CLM-426884
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005834
Orphan claim re-pointed
Claims processor
CLM-400990 → UHC-79174-43 (Amber Greene)
Member id
UHC-79174-43
Confidence
1
Method
probabilistic
MBR-016235CLM-400990
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005835
Orphan claim re-pointed
Claims processor
CLM-415703 → UHC-25722-63 (Juan Williams)
Member id
UHC-25722-63
Confidence
1
Method
probabilistic
MBR-019216CLM-415703
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005836
Orphan claim re-pointed
Claims processor
CLM-403153 → UHC-72060-79 (Patrick Carter)
Member id
UHC-72060-79
Confidence
0.93
Method
probabilistic
MBR-023271CLM-403153
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005837
Orphan claim re-pointed
Claims processor
CLM-431702 → UHC-71837-12 (Samuel Gardner)
Member id
UHC-71837-12
Confidence
1
Method
probabilistic
MBR-004364CLM-431702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005838
Orphan claim re-pointed
Claims processor
CLM-418546 → UHC-49440-91 (Jean Wang)
Member id
UHC-49440-91
Confidence
0.99
Method
probabilistic
MBR-000276CLM-418546
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005839
Orphan claim re-pointed
Claims processor
CLM-411341 → UHC-35061-76 (Billy Hansen)
Member id
UHC-35061-76
Confidence
1
Method
probabilistic
MBR-016342CLM-411341
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 90 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.