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

TypeAllOrphan claim re-pointed9,112
StatusAllProposed8,228Executed14,086Held4,326Released0
ActionTypeTitleDetailLinked toStatusExecuted
ACT-006740
Orphan claim re-pointed
Claims processor
CLM-419873 → UHC-06575-07 (Ronald Burton)
Member id
UHC-06575-07
Confidence
0.97
Method
deterministic
MBR-035261CLM-419873
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006741
Orphan claim re-pointed
Claims processor
CLM-422199 → UHC-87463-27 (Joyce Reynolds)
Member id
UHC-87463-27
Confidence
0.97
Method
deterministic
MBR-026034CLM-422199
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006742
Orphan claim re-pointed
Claims processor
CLM-411855 → UHC-97023-90 (Chirstian Henderson)
Member id
UHC-97023-90
Confidence
0.97
Method
deterministic
MBR-007017CLM-411855
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006743
Orphan claim re-pointed
Claims processor
CLM-414192 → UHC-19695-21 (Henry Holmes)
Member id
UHC-19695-21
Confidence
1
Method
probabilistic
MBR-039441CLM-414192
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006744
Orphan claim re-pointed
Claims processor
CLM-431842 → UHC-72484-78 (Juan Williams)
Member id
UHC-72484-78
Confidence
1
Method
probabilistic
MBR-035022CLM-431842
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006745
Orphan claim re-pointed
Claims processor
CLM-424911 → UHC-60029-27 (Russell Dunn)
Member id
UHC-60029-27
Confidence
1
Method
probabilistic
MBR-005708CLM-424911
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006746
Orphan claim re-pointed
Claims processor
CLM-400095 → UHC-22998-79 (Cooper Justin)
Member id
UHC-22998-79
Confidence
1
Method
probabilistic
MBR-024290CLM-400095
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006747
Orphan claim re-pointed
Claims processor
CLM-415986 → UHC-27825-83 (Patrick Fisher)
Member id
UHC-27825-83
Confidence
0.99
Method
probabilistic
MBR-008563CLM-415986
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006748
Orphan claim re-pointed
Claims processor
CLM-413627 → UHC-89806-73 (Tyler Medina)
Member id
UHC-89806-73
Confidence
1
Method
probabilistic
MBR-009222CLM-413627
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006749
Orphan claim re-pointed
Claims processor
CLM-419601 → UHC-23464-33 (Frances George)
Member id
UHC-23464-33
Confidence
0.97
Method
deterministic
MBR-027591CLM-419601
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006750
Orphan claim re-pointed
Claims processor
CLM-411366 → UHC-56495-72 (Elizabeth Ray)
Member id
UHC-56495-72
Confidence
1
Method
probabilistic
MBR-018083CLM-411366
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006751
Orphan claim re-pointed
Claims processor
CLM-426107 → UHC-27206-41 (Rachel Wagner)
Member id
UHC-27206-41
Confidence
1
Method
probabilistic
MBR-007541CLM-426107
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006752
Orphan claim re-pointed
Claims processor
CLM-423460 → UHC-60980-69 (Kevin Franklin)
Member id
UHC-60980-69
Confidence
0.90
Method
probabilistic
MBR-002581CLM-423460
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006753
Orphan claim re-pointed
Claims processor
CLM-422705 → UHC-75540-38 (Virginia Cunningham)
Member id
UHC-75540-38
Confidence
1
Method
probabilistic
MBR-005449CLM-422705
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006754
Orphan claim re-pointed
Claims processor
CLM-405009 → UHC-56192-61 (Richard Morgan)
Member id
UHC-56192-61
Confidence
1
Method
probabilistic
MBR-016953CLM-405009
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006755
Orphan claim re-pointed
Claims processor
CLM-404937 → UHC-72712-60 (Sara Berry)
Member id
UHC-72712-60
Confidence
0.97
Method
deterministic
MBR-032162CLM-404937
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006756
Orphan claim re-pointed
Claims processor
CLM-401730 → UHC-13539-41 (Yuki Brown)
Member id
UHC-13539-41
Confidence
1
Method
probabilistic
MBR-023667CLM-401730
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006757
Orphan claim re-pointed
Claims processor
CLM-418173 → UHC-53723-54 (Noah Wallace)
Member id
UHC-53723-54
Confidence
1
Method
probabilistic
MBR-005514CLM-418173
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006758
Orphan claim re-pointed
Claims processor
CLM-416285 → UHC-49851-73 (Mei Turner)
Member id
UHC-49851-73
Confidence
1
Method
probabilistic
MBR-024711CLM-416285
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006759
Orphan claim re-pointed
Claims processor
CLM-404928 → UHC-99163-01 (Vincent Hart)
Member id
UHC-99163-01
Confidence
0.97
Method
deterministic
MBR-031356CLM-404928
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006760
Orphan claim re-pointed
Claims processor
CLM-425734 → UHC-29175-45 (Amber Jordan)
Member id
UHC-29175-45
Confidence
1
Method
probabilistic
MBR-006806CLM-425734
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006761
Orphan claim re-pointed
Claims processor
CLM-426868 → UHC-65237-74 (Wei Garza)
Member id
UHC-65237-74
Confidence
1
Method
probabilistic
MBR-004192CLM-426868
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006762
Orphan claim re-pointed
Claims processor
CLM-426486 → UHC-54492-80 (Jesse Freeman)
Member id
UHC-54492-80
Confidence
1
Method
probabilistic
MBR-012624CLM-426486
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006763
Orphan claim re-pointed
Claims processor
CLM-420202 → UHC-63561-95 (Alexis Armstrong)
Member id
UHC-63561-95
Confidence
0.97
Method
deterministic
MBR-005579CLM-420202
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006764
Orphan claim re-pointed
Claims processor
CLM-424812 → UHC-96827-16 (Daniel Green)
Member id
UHC-96827-16
Confidence
0.97
Method
deterministic
MBR-012142CLM-424812
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006765
Orphan claim re-pointed
Claims processor
CLM-401839 → UHC-14204-71 (Hiroshi Reynolds)
Member id
UHC-14204-71
Confidence
1
Method
probabilistic
MBR-033076CLM-401839
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006766
Orphan claim re-pointed
Claims processor
CLM-422578 → UHC-66106-28 (Thomas Santos)
Member id
UHC-66106-28
Confidence
0.97
Method
deterministic
MBR-034074CLM-422578
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006767
Orphan claim re-pointed
Claims processor
CLM-428153 → UHC-03625-33 (Gloria Yang)
Member id
UHC-03625-33
Confidence
0.93
Method
probabilistic
MBR-002474CLM-428153
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006768
Orphan claim re-pointed
Claims processor
CLM-423234 → UHC-08296-83 (Jeremy Hanson)
Member id
UHC-08296-83
Confidence
1
Method
probabilistic
MBR-021658CLM-423234
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006769
Orphan claim re-pointed
Claims processor
CLM-428204 → UHC-04373-65 (Andrea Reyes)
Member id
UHC-04373-65
Confidence
1
Method
probabilistic
MBR-004250CLM-428204
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006770
Orphan claim re-pointed
Claims processor
CLM-418205 → UHC-92780-76 (Sharon Fowler)
Member id
UHC-92780-76
Confidence
1
Method
probabilistic
MBR-020027CLM-418205
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006771
Orphan claim re-pointed
Claims processor
CLM-414734 → UHC-17061-12 (Shirley Alvarez)
Member id
UHC-17061-12
Confidence
1
Method
probabilistic
MBR-042032CLM-414734
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006772
Orphan claim re-pointed
Claims processor
CLM-425407 → UHC-57765-55 (Kelly Herrera)
Member id
UHC-57765-55
Confidence
1
Method
probabilistic
MBR-025064CLM-425407
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006773
Orphan claim re-pointed
Claims processor
CLM-418475 → UHC-01651-17 (Ana Ward)
Member id
UHC-01651-17
Confidence
1
Method
probabilistic
MBR-030728CLM-418475
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006774
Orphan claim re-pointed
Claims processor
CLM-431267 → UHC-15710-14 (Alice Ortiz)
Member id
UHC-15710-14
Confidence
1
Method
probabilistic
MBR-000574CLM-431267
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006775
Orphan claim re-pointed
Claims processor
CLM-404262 → UHC-18244-83 (Beverly Cruz)
Member id
UHC-18244-83
Confidence
0.99
Method
probabilistic
MBR-000487CLM-404262
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006776
Orphan claim re-pointed
Claims processor
CLM-421581 → UHC-19189-76 (Tyler Maldonado)
Member id
UHC-19189-76
Confidence
1
Method
probabilistic
MBR-011078CLM-421581
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006777
Orphan claim re-pointed
Claims processor
CLM-409945 → UHC-04770-46 (Lucia Woods)
Member id
UHC-04770-46
Confidence
0.99
Method
probabilistic
MBR-018482CLM-409945
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006778
Orphan claim re-pointed
Claims processor
CLM-424304 → UHC-83799-46 (Ryan Reed)
Member id
UHC-83799-46
Confidence
1
Method
probabilistic
MBR-029483CLM-424304
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006779
Orphan claim re-pointed
Claims processor
CLM-417740 → UHC-66759-58 (Olivia Duncan)
Member id
UHC-66759-58
Confidence
1
Method
probabilistic
MBR-002561CLM-417740
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006780
Orphan claim re-pointed
Claims processor
CLM-418937 → UHC-17261-98 (Eugene Fuller)
Member id
UHC-17261-98
Confidence
1
Method
probabilistic
MBR-020480CLM-418937
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006781
Orphan claim re-pointed
Claims processor
CLM-404712 → UHC-84483-96 (Mary Austin)
Member id
UHC-84483-96
Confidence
0.90
Method
probabilistic
MBR-040635CLM-404712
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006782
Orphan claim re-pointed
Claims processor
CLM-423035 → UHC-45067-31 (Camila Guerrero)
Member id
UHC-45067-31
Confidence
1
Method
probabilistic
MBR-010489CLM-423035
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006783
Orphan claim re-pointed
Claims processor
CLM-417817 → UHC-39422-02 (Amy Ferguson)
Member id
UHC-39422-02
Confidence
1
Method
probabilistic
MBR-017763CLM-417817
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006784
Orphan claim re-pointed
Claims processor
CLM-416443 → UHC-65456-50 (Janice Ramos)
Member id
UHC-65456-50
Confidence
1
Method
probabilistic
MBR-011714CLM-416443
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006785
Orphan claim re-pointed
Claims processor
CLM-426716 → UHC-21038-92 (Melissa Butler)
Member id
UHC-21038-92
Confidence
0.99
Method
probabilistic
MBR-034075CLM-426716
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006786
Orphan claim re-pointed
Claims processor
CLM-417018 → UHC-62623-61 (Jean Andrews)
Member id
UHC-62623-61
Confidence
0.97
Method
deterministic
MBR-009910CLM-417018
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006787
Orphan claim re-pointed
Claims processor
CLM-430940 → UHC-64949-34 (Michelle Bowman)
Member id
UHC-64949-34
Confidence
1
Method
probabilistic
MBR-013784CLM-430940
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006788
Orphan claim re-pointed
Claims processor
CLM-427198 → UHC-41359-99 (Olivia Maldonado)
Member id
UHC-41359-99
Confidence
0.94
Method
probabilistic
MBR-026506CLM-427198
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006789
Orphan claim re-pointed
Claims processor
CLM-416288 → UHC-98234-91 (Bryan Gonzales)
Member id
UHC-98234-91
Confidence
0.97
Method
deterministic
MBR-002737CLM-416288
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 109 of 183PreviousNext

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.