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-005990
Orphan claim re-pointed
Claims processor
CLM-431773 → UHC-03440-99 (Arjun Reies)
Member id
UHC-03440-99
Confidence
0.98
Method
probabilistic
MBR-019784CLM-431773
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005991
Orphan claim re-pointed
Claims processor
CLM-402579 → UHC-16722-55 (Teresa McCoy)
Member id
UHC-16722-55
Confidence
1
Method
probabilistic
MBR-033009CLM-402579
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005992
Orphan claim re-pointed
Claims processor
CLM-408415 → UHC-47425-07 (James Burke)
Member id
UHC-47425-07
Confidence
0.88
Method
probabilistic
MBR-024328CLM-408415
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005993
Orphan claim re-pointed
Claims processor
CLM-430479 → UHC-43570-25 (Nicholas Oliver)
Member id
UHC-43570-25
Confidence
0.97
Method
deterministic
MBR-018859CLM-430479
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005994
Orphan claim re-pointed
Claims processor
CLM-404749 → UHC-78406-35 (Gabriel Moreno)
Member id
UHC-78406-35
Confidence
1
Method
probabilistic
MBR-000979CLM-404749
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005995
Orphan claim re-pointed
Claims processor
CLM-415598 → UHC-41853-46 (Ruth Hall)
Member id
UHC-41853-46
Confidence
1
Method
probabilistic
MBR-000575CLM-415598
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005996
Orphan claim re-pointed
Claims processor
CLM-404433 → UHC-00221-37 (Scott Moreno)
Member id
UHC-00221-37
Confidence
1
Method
probabilistic
MBR-009072CLM-404433
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005997
Orphan claim re-pointed
Claims processor
CLM-409396 → UHC-60400-11 (Susan Greene)
Member id
UHC-60400-11
Confidence
1
Method
probabilistic
MBR-027183CLM-409396
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005998
Orphan claim re-pointed
Claims processor
CLM-431208 → UHC-13043-98 (Samantha Burton)
Member id
UHC-13043-98
Confidence
1.00
Method
probabilistic
MBR-012931CLM-431208
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005999
Orphan claim re-pointed
Claims processor
CLM-419724 → UHC-64455-52 (Aisha Russell)
Member id
UHC-64455-52
Confidence
1
Method
probabilistic
MBR-018074CLM-419724
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006000
Orphan claim re-pointed
Claims processor
CLM-412526 → UHC-53297-26 (Jon Parker)
Member id
UHC-53297-26
Confidence
1
Method
probabilistic
MBR-000908CLM-412526
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006001
Orphan claim re-pointed
Claims processor
CLM-426768 → UHC-24354-61 (Virginia Green)
Member id
UHC-24354-61
Confidence
1
Method
probabilistic
MBR-015386CLM-426768
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006002
Orphan claim re-pointed
Claims processor
CLM-418522 → UHC-87779-65 (Andrea Brown)
Member id
UHC-87779-65
Confidence
0.97
Method
deterministic
MBR-008763CLM-418522
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006003
Orphan claim re-pointed
Claims processor
CLM-425085 → UHC-94738-62 (Steven Jensen)
Member id
UHC-94738-62
Confidence
0.99
Method
probabilistic
MBR-037691CLM-425085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006004
Orphan claim re-pointed
Claims processor
CLM-423995 → UHC-86250-15 (Karen Harrison)
Member id
UHC-86250-15
Confidence
0.99
Method
probabilistic
MBR-001009CLM-423995
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006005
Orphan claim re-pointed
Claims processor
CLM-405157 → UHC-32649-36 (Alexis Fox)
Member id
UHC-32649-36
Confidence
1
Method
probabilistic
MBR-015084CLM-405157
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006006
Orphan claim re-pointed
Claims processor
CLM-414048 → UHC-76032-71 (Mason Le)
Member id
UHC-76032-71
Confidence
0.97
Method
deterministic
MBR-030910CLM-414048
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006007
Orphan claim re-pointed
Claims processor
CLM-409583 → UHC-53110-32 (Jennifer Riley)
Member id
UHC-53110-32
Confidence
1
Method
probabilistic
MBR-011198CLM-409583
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006008
Orphan claim re-pointed
Claims processor
CLM-404713 → UHC-84483-96 (Mary Austin)
Member id
UHC-84483-96
Confidence
1
Method
probabilistic
MBR-040635CLM-404713
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006009
Orphan claim re-pointed
Claims processor
CLM-427040 → UHC-75863-44 (Christina Lynch)
Member id
UHC-75863-44
Confidence
1.00
Method
probabilistic
MBR-005464CLM-427040
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006010
Orphan claim re-pointed
Claims processor
CLM-423477 → UHC-70943-35 (Mariana Obrien)
Member id
UHC-70943-35
Confidence
0.97
Method
deterministic
MBR-011982CLM-423477
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006011
Orphan claim re-pointed
Claims processor
CLM-408193 → UHC-30933-70 (Larry Patterson)
Member id
UHC-30933-70
Confidence
1
Method
probabilistic
MBR-021893CLM-408193
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006012
Orphan claim re-pointed
Claims processor
CLM-430819 → UHC-68161-24 (Timothy Edwards)
Member id
UHC-68161-24
Confidence
1
Method
probabilistic
MBR-003875CLM-430819
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006013
Orphan claim re-pointed
Claims processor
CLM-406068 → UHC-46484-67 (Julie Vasquez)
Member id
UHC-46484-67
Confidence
0.99
Method
probabilistic
MBR-021816CLM-406068
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006014
Orphan claim re-pointed
Claims processor
CLM-407213 → UHC-59562-45 (Kimberly Munoz)
Member id
UHC-59562-45
Confidence
1
Method
probabilistic
MBR-033665CLM-407213
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006015
Orphan claim re-pointed
Claims processor
CLM-408778 → UHC-05379-68 (Karen Jackson)
Member id
UHC-05379-68
Confidence
0.97
Method
deterministic
MBR-025940CLM-408778
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006016
Orphan claim re-pointed
Claims processor
CLM-401023 → UHC-64353-07 (Russell Burton)
Member id
UHC-64353-07
Confidence
1
Method
probabilistic
MBR-004777CLM-401023
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006017
Orphan claim re-pointed
Claims processor
CLM-412198 → UHC-77913-35 (Mark Tran)
Member id
UHC-77913-35
Confidence
0.97
Method
deterministic
MBR-004473CLM-412198
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006018
Orphan claim re-pointed
Claims processor
CLM-423901 → UHC-59443-95 (Sue Medina)
Member id
UHC-59443-95
Confidence
0.97
Method
deterministic
MBR-030311CLM-423901
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006019
Orphan claim re-pointed
Claims processor
CLM-405921 → UHC-06063-03 (Steven Ortega)
Member id
UHC-06063-03
Confidence
0.98
Method
probabilistic
MBR-015625CLM-405921
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006020
Orphan claim re-pointed
Claims processor
CLM-409899 → UHC-09453-25 (Martha Gonzales)
Member id
UHC-09453-25
Confidence
1
Method
probabilistic
MBR-015076CLM-409899
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006021
Orphan claim re-pointed
Claims processor
CLM-423180 → UHC-16103-42 (Karen Campbell)
Member id
UHC-16103-42
Confidence
1
Method
probabilistic
MBR-026112CLM-423180
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006022
Orphan claim re-pointed
Claims processor
CLM-424978 → UHC-49053-18 (Denise Anderson)
Member id
UHC-49053-18
Confidence
1
Method
probabilistic
MBR-024386CLM-424978
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006023
Orphan claim re-pointed
Claims processor
CLM-418191 → UHC-69143-25 (Jacqueline Andrews)
Member id
UHC-69143-25
Confidence
0.97
Method
deterministic
MBR-017744CLM-418191
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006024
Orphan claim re-pointed
Claims processor
CLM-420544 → UHC-67709-81 (Omar Lopez)
Member id
UHC-67709-81
Confidence
0.97
Method
deterministic
MBR-001042CLM-420544
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006025
Orphan claim re-pointed
Claims processor
CLM-413914 → UHC-21572-47 (Arthur Marshall)
Member id
UHC-21572-47
Confidence
0.94
Method
probabilistic
MBR-012895CLM-413914
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006026
Orphan claim re-pointed
Claims processor
CLM-430575 → UHC-01568-37 (Arthur Robertson)
Member id
UHC-01568-37
Confidence
1
Method
probabilistic
MBR-005446CLM-430575
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006027
Orphan claim re-pointed
Claims processor
CLM-423241 → UHC-07284-72 (Lisa Anderson)
Member id
UHC-07284-72
Confidence
1
Method
probabilistic
MBR-023161CLM-423241
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006028
Orphan claim re-pointed
Claims processor
CLM-407064 → UHC-79424-39 (Stephanie Hart)
Member id
UHC-79424-39
Confidence
0.94
Method
probabilistic
MBR-012523CLM-407064
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006029
Orphan claim re-pointed
Claims processor
CLM-404806 → UHC-58390-27 (Laura Washington)
Member id
UHC-58390-27
Confidence
0.97
Method
deterministic
MBR-034271CLM-404806
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006030
Orphan claim re-pointed
Claims processor
CLM-431854 → UHC-47672-96 (Mateo Ortiz)
Member id
UHC-47672-96
Confidence
1
Method
probabilistic
MBR-024888CLM-431854
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006031
Orphan claim re-pointed
Claims processor
CLM-413590 → UHC-59600-25 (Ahmed Hayes)
Member id
UHC-59600-25
Confidence
1
Method
probabilistic
MBR-033779CLM-413590
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006032
Orphan claim re-pointed
Claims processor
CLM-429140 → UHC-12791-74 (Carl Gibson)
Member id
UHC-12791-74
Confidence
1
Method
probabilistic
MBR-030938CLM-429140
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006033
Orphan claim re-pointed
Claims processor
CLM-418085 → UHC-00748-41 (Lucia Montgomery)
Member id
UHC-00748-41
Confidence
1
Method
probabilistic
MBR-006112CLM-418085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006034
Orphan claim re-pointed
Claims processor
CLM-427655 → UHC-73287-27 (Kimberly Medina)
Member id
UHC-73287-27
Confidence
0.97
Method
deterministic
MBR-012048CLM-427655
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006035
Orphan claim re-pointed
Claims processor
CLM-410081 → UHC-90832-95 (Bobby Walsh)
Member id
UHC-90832-95
Confidence
1
Method
probabilistic
MBR-029310CLM-410081
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006036
Orphan claim re-pointed
Claims processor
CLM-407938 → UHC-50774-33 (Willie Robertson)
Member id
UHC-50774-33
Confidence
0.97
Method
deterministic
MBR-036972CLM-407938
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006037
Orphan claim re-pointed
Claims processor
CLM-411662 → UHC-39381-75 (Alexander Cruz)
Member id
UHC-39381-75
Confidence
0.97
Method
deterministic
MBR-009400CLM-411662
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006038
Orphan claim re-pointed
Claims processor
CLM-408485 → UHC-71172-51 (Ralph Johnston)
Member id
UHC-71172-51
Confidence
1
Method
probabilistic
MBR-011558CLM-408485
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006039
Orphan claim re-pointed
Claims processor
CLM-405019 → UHC-26434-29 (Abigail George)
Member id
UHC-26434-29
Confidence
1
Method
probabilistic
MBR-007370CLM-405019
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 94 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.