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-006190
Orphan claim re-pointed
Claims processor
CLM-412161 → UHC-63588-98 (Deborah Harper)
Member id
UHC-63588-98
Confidence
1
Method
probabilistic
MBR-015621CLM-412161
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006191
Orphan claim re-pointed
Claims processor
CLM-424717 → UHC-33688-95 (Tyler Brooks)
Member id
UHC-33688-95
Confidence
0.99
Method
probabilistic
MBR-012490CLM-424717
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006192
Orphan claim re-pointed
Claims processor
CLM-413429 → UHC-31656-92 (Gabriel Gray)
Member id
UHC-31656-92
Confidence
1
Method
probabilistic
MBR-026037CLM-413429
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006193
Orphan claim re-pointed
Claims processor
CLM-429674 → UHC-32037-03 (Rachel Baker)
Member id
UHC-32037-03
Confidence
1
Method
probabilistic
MBR-002200CLM-429674
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006194
Orphan claim re-pointed
Claims processor
CLM-425944 → UHC-55654-50 (Donald Peters)
Member id
UHC-55654-50
Confidence
1
Method
probabilistic
MBR-023438CLM-425944
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006195
Orphan claim re-pointed
Claims processor
CLM-406982 → UHC-00239-37 (Mary Salazar)
Member id
UHC-00239-37
Confidence
1
Method
probabilistic
MBR-026341CLM-406982
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006196
Orphan claim re-pointed
Claims processor
CLM-430565 → UHC-34472-84 (Logan Greene)
Member id
UHC-34472-84
Confidence
1
Method
probabilistic
MBR-013376CLM-430565
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006197
Orphan claim re-pointed
Claims processor
CLM-409944 → UHC-74053-63 (Gerald Carpenter)
Member id
UHC-74053-63
Confidence
1
Method
probabilistic
MBR-011696CLM-409944
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006198
Orphan claim re-pointed
Claims processor
CLM-421153 → UHC-34357-45 (Scott Rogers)
Member id
UHC-34357-45
Confidence
0.97
Method
deterministic
MBR-013047CLM-421153
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006199
Orphan claim re-pointed
Claims processor
CLM-418946 → UHC-72154-88 (Patrick Ford)
Member id
UHC-72154-88
Confidence
0.97
Method
deterministic
MBR-018106CLM-418946
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006200
Orphan claim re-pointed
Claims processor
CLM-413143 → UHC-20494-29 (Christina Carter)
Member id
UHC-20494-29
Confidence
0.98
Method
probabilistic
MBR-015185CLM-413143
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006201
Orphan claim re-pointed
Claims processor
CLM-412725 → UHC-96949-18 (Ann Welch)
Member id
UHC-96949-18
Confidence
0.98
Method
probabilistic
MBR-002728CLM-412725
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006202
Orphan claim re-pointed
Claims processor
CLM-419320 → UHC-42042-21 (Diane Parker)
Member id
UHC-42042-21
Confidence
0.97
Method
deterministic
MBR-021416CLM-419320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006203
Orphan claim re-pointed
Claims processor
CLM-400954 → UHC-31286-37 (Camila Santos)
Member id
UHC-31286-37
Confidence
1
Method
probabilistic
MBR-017989CLM-400954
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006204
Orphan claim re-pointed
Claims processor
CLM-406891 → UHC-48815-83 (Albert Miller)
Member id
UHC-48815-83
Confidence
0.97
Method
deterministic
MBR-027380CLM-406891
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006205
Orphan claim re-pointed
Claims processor
CLM-409980 → UHC-64251-76 (Jack Allen)
Member id
UHC-64251-76
Confidence
0.97
Method
deterministic
MBR-018551CLM-409980
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006206
Orphan claim re-pointed
Claims processor
CLM-430543 → UHC-80172-58 (Lauren Ryan)
Member id
UHC-80172-58
Confidence
0.98
Method
probabilistic
MBR-002598CLM-430543
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006207
Orphan claim re-pointed
Claims processor
CLM-421454 → UHC-93320-87 (Bruce Jensen)
Member id
UHC-93320-87
Confidence
1
Method
probabilistic
MBR-014734CLM-421454
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006208
Orphan claim re-pointed
Claims processor
CLM-414618 → UHC-42338-82 (Cynthia Chavez)
Member id
UHC-42338-82
Confidence
0.93
Method
probabilistic
MBR-022173CLM-414618
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006209
Orphan claim re-pointed
Claims processor
CLM-405632 → UHC-80846-56 (Bruce Foster)
Member id
UHC-80846-56
Confidence
0.99
Method
probabilistic
MBR-027118CLM-405632
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006210
Orphan claim re-pointed
Claims processor
CLM-417823 → UHC-37451-74 (Larry Lynch)
Member id
UHC-37451-74
Confidence
0.87
Method
probabilistic
MBR-029061CLM-417823
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006211
Orphan claim re-pointed
Claims processor
CLM-406743 → UHC-46016-18 (Gloria Stone)
Member id
UHC-46016-18
Confidence
1
Method
probabilistic
MBR-024106CLM-406743
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006212
Orphan claim re-pointed
Claims processor
CLM-418201 → UHC-65814-20 (Deborah Estrada)
Member id
UHC-65814-20
Confidence
1
Method
probabilistic
MBR-018387CLM-418201
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006213
Orphan claim re-pointed
Claims processor
CLM-427987 → UHC-18318-35 (George Myers)
Member id
UHC-18318-35
Confidence
1
Method
probabilistic
MBR-014617CLM-427987
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006214
Orphan claim re-pointed
Claims processor
CLM-409729 → UHC-44506-47 (Samantha Patterson)
Member id
UHC-44506-47
Confidence
1
Method
probabilistic
MBR-018589CLM-409729
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006215
Orphan claim re-pointed
Claims processor
CLM-431040 → UHC-83521-36 (Anthony Gibson)
Member id
UHC-83521-36
Confidence
1
Method
probabilistic
MBR-015359CLM-431040
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006216
Orphan claim re-pointed
Claims processor
CLM-406842 → UHC-44229-06 (Charles Lewis)
Member id
UHC-44229-06
Confidence
0.98
Method
probabilistic
MBR-005776CLM-406842
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006217
Orphan claim re-pointed
Claims processor
CLM-419733 → UHC-30792-11 (Jennifer Luna)
Member id
UHC-30792-11
Confidence
1
Method
probabilistic
MBR-041315CLM-419733
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006218
Orphan claim re-pointed
Claims processor
CLM-409176 → UHC-03136-61 (Camila Peterson)
Member id
UHC-03136-61
Confidence
1
Method
probabilistic
MBR-040756CLM-409176
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006219
Orphan claim re-pointed
Claims processor
CLM-400484 → UHC-16126-85 (Santiago Peters)
Member id
UHC-16126-85
Confidence
1
Method
probabilistic
MBR-025187CLM-400484
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006220
Orphan claim re-pointed
Claims processor
CLM-429952 → UHC-09608-97 (Danielle Young)
Member id
UHC-09608-97
Confidence
1
Method
probabilistic
MBR-020602CLM-429952
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006221
Orphan claim re-pointed
Claims processor
CLM-416239 → UHC-07810-03 (Jeremy Roberts)
Member id
UHC-07810-03
Confidence
1
Method
probabilistic
MBR-008893CLM-416239
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006222
Orphan claim re-pointed
Claims processor
CLM-416983 → UHC-34661-92 (Walter Washington)
Member id
UHC-34661-92
Confidence
1
Method
probabilistic
MBR-007842CLM-416983
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006223
Orphan claim re-pointed
Claims processor
CLM-419142 → UHC-55774-23 (Yuki Perkins)
Member id
UHC-55774-23
Confidence
1
Method
probabilistic
MBR-010173CLM-419142
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006224
Orphan claim re-pointed
Claims processor
CLM-426623 → UHC-11062-05 (Tony Hunt)
Member id
UHC-11062-05
Confidence
0.99
Method
probabilistic
MBR-019076CLM-426623
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006225
Orphan claim re-pointed
Claims processor
CLM-411386 → UHC-41662-03 (Nathan Gutierrez)
Member id
UHC-41662-03
Confidence
1
Method
probabilistic
MBR-001901CLM-411386
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006226
Orphan claim re-pointed
Claims processor
CLM-417045 → UHC-99921-94 (Thomas Foster)
Member id
UHC-99921-94
Confidence
0.97
Method
probabilistic
MBR-003625CLM-417045
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006227
Orphan claim re-pointed
Claims processor
CLM-415798 → UHC-07594-37 (Joe Diaz)
Member id
UHC-07594-37
Confidence
0.93
Method
probabilistic
MBR-018364CLM-415798
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006228
Orphan claim re-pointed
Claims processor
CLM-409949 → UHC-52082-68 (Ahmed West)
Member id
UHC-52082-68
Confidence
1
Method
probabilistic
MBR-028912CLM-409949
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006229
Orphan claim re-pointed
Claims processor
CLM-418851 → UHC-18708-72 (Douglas McDonald)
Member id
UHC-18708-72
Confidence
1
Method
probabilistic
MBR-006696CLM-418851
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006230
Orphan claim re-pointed
Claims processor
CLM-406133 → UHC-24750-67 (Lori Rodriguez)
Member id
UHC-24750-67
Confidence
0.97
Method
deterministic
MBR-009422CLM-406133
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006231
Orphan claim re-pointed
Claims processor
CLM-418281 → UHC-54533-25 (Abigail Aguilar)
Member id
UHC-54533-25
Confidence
1
Method
probabilistic
MBR-007690CLM-418281
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006232
Orphan claim re-pointed
Claims processor
CLM-432012 → UHC-49736-25 (Doris Nunez)
Member id
UHC-49736-25
Confidence
1
Method
probabilistic
MBR-006293CLM-432012
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006233
Orphan claim re-pointed
Claims processor
CLM-421037 → UHC-85134-32 (Evelyn Gray)
Member id
UHC-85134-32
Confidence
0.97
Method
deterministic
MBR-012584CLM-421037
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006234
Orphan claim re-pointed
Claims processor
CLM-423780 → UHC-97733-79 (Gloria Miller)
Member id
UHC-97733-79
Confidence
1
Method
probabilistic
MBR-005308CLM-423780
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006235
Orphan claim re-pointed
Claims processor
CLM-415762 → UHC-91168-07 (Emily Fuller)
Member id
UHC-91168-07
Confidence
1
Method
probabilistic
MBR-000376CLM-415762
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006236
Orphan claim re-pointed
Claims processor
CLM-420586 → UHC-27339-67 (Margaret Carlson)
Member id
UHC-27339-67
Confidence
0.86
Method
probabilistic
MBR-034379CLM-420586
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006237
Orphan claim re-pointed
Claims processor
CLM-403079 → UHC-50013-23 (Roy Howell)
Member id
UHC-50013-23
Confidence
1
Method
probabilistic
MBR-013990CLM-403079
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006238
Orphan claim re-pointed
Claims processor
CLM-409439 → UHC-09336-70 (Emily Stewart)
Member id
UHC-09336-70
Confidence
0.97
Method
deterministic
MBR-000662CLM-409439
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006239
Orphan claim re-pointed
Claims processor
CLM-422801 → UHC-61797-78 (Kyle Freeman)
Member id
UHC-61797-78
Confidence
1
Method
probabilistic
MBR-028146CLM-422801
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 98 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.