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-001840
Orphan claim re-pointed
Claims processor
CLM-407123 → UHC-54614-81 (Gerald Kennedy)
Member id
UHC-54614-81
Confidence
0.99
Method
probabilistic
MBR-008691CLM-407123
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001841
Orphan claim re-pointed
Claims processor
CLM-410217 → UHC-06564-81 (David Yang)
Member id
UHC-06564-81
Confidence
1
Method
probabilistic
MBR-018330CLM-410217
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001842
Orphan claim re-pointed
Claims processor
CLM-416307 → UHC-14526-69 (Virginia Hunter)
Member id
UHC-14526-69
Confidence
0.97
Method
deterministic
MBR-039442CLM-416307
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001843
Orphan claim re-pointed
Claims processor
CLM-420069 → UHC-13976-98 (Emma Ramos)
Member id
UHC-13976-98
Confidence
1
Method
probabilistic
MBR-015329CLM-420069
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001844
Orphan claim re-pointed
Claims processor
CLM-428714 → UHC-81755-94 (Omar Cruz)
Member id
UHC-81755-94
Confidence
1
Method
probabilistic
MBR-031151CLM-428714
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001845
Orphan claim re-pointed
Claims processor
CLM-417167 → UHC-31996-82 (Matthew Williamson)
Member id
UHC-31996-82
Confidence
1
Method
probabilistic
MBR-024817CLM-417167
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001846
Orphan claim re-pointed
Claims processor
CLM-412682 → UHC-56887-73 (Luis Lee)
Member id
UHC-56887-73
Confidence
0.99
Method
probabilistic
MBR-008147CLM-412682
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001847
Orphan claim re-pointed
Claims processor
CLM-428705 → UHC-76593-95 (Kathryn Carlson)
Member id
UHC-76593-95
Confidence
0.97
Method
deterministic
MBR-008784CLM-428705
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001848
Orphan claim re-pointed
Claims processor
CLM-413479 → UHC-29432-01 (Carol Gonzalez)
Member id
UHC-29432-01
Confidence
1
Method
probabilistic
MBR-010914CLM-413479
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001849
Orphan claim re-pointed
Claims processor
CLM-430086 → UHC-35018-52 (Amy Butler)
Member id
UHC-35018-52
Confidence
1
Method
probabilistic
MBR-019760CLM-430086
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001850
Orphan claim re-pointed
Claims processor
CLM-410909 → UHC-70476-15 (Carol Hughes)
Member id
UHC-70476-15
Confidence
1
Method
probabilistic
MBR-041840CLM-410909
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001851
Orphan claim re-pointed
Claims processor
CLM-406832 → UHC-83948-75 (Philip Woods)
Member id
UHC-83948-75
Confidence
1.00
Method
probabilistic
MBR-012019CLM-406832
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001852
Orphan claim re-pointed
Claims processor
CLM-422209 → UHC-89453-55 (Vincent Morgan)
Member id
UHC-89453-55
Confidence
0.97
Method
deterministic
MBR-000577CLM-422209
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001853
Orphan claim re-pointed
Claims processor
CLM-432164 → UHC-72535-35 (Rachel Holmes)
Member id
UHC-72535-35
Confidence
1
Method
probabilistic
MBR-015508CLM-432164
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001854
Orphan claim re-pointed
Claims processor
CLM-410999 → UHC-77031-08 (Jimmy Watkins)
Member id
UHC-77031-08
Confidence
1
Method
probabilistic
MBR-002822CLM-410999
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001855
Orphan claim re-pointed
Claims processor
CLM-402758 → UHC-45402-41 (James Ortiz)
Member id
UHC-45402-41
Confidence
1
Method
probabilistic
MBR-034607CLM-402758
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001856
Orphan claim re-pointed
Claims processor
CLM-432560 → UHC-35446-77 (Amanda Bennett)
Member id
UHC-35446-77
Confidence
1
Method
probabilistic
MBR-000305CLM-432560
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001857
Orphan claim re-pointed
Claims processor
CLM-432419 → UHC-25443-03 (Barbara Nichols)
Member id
UHC-25443-03
Confidence
1
Method
probabilistic
MBR-018489CLM-432419
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001858
Orphan claim re-pointed
Claims processor
CLM-417706 → UHC-77127-65 (Betty Knight)
Member id
UHC-77127-65
Confidence
0.97
Method
deterministic
MBR-007290CLM-417706
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001859
Orphan claim re-pointed
Claims processor
CLM-418167 → UHC-71686-49 (Ana Jackson)
Member id
UHC-71686-49
Confidence
1
Method
probabilistic
MBR-031010CLM-418167
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001860
Orphan claim re-pointed
Claims processor
CLM-429823 → UHC-09008-65 (Hannah Larson)
Member id
UHC-09008-65
Confidence
1
Method
probabilistic
MBR-000237CLM-429823
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001861
Orphan claim re-pointed
Claims processor
CLM-401161 → UHC-58991-88 (Bryan Hansen)
Member id
UHC-58991-88
Confidence
1
Method
probabilistic
MBR-001466CLM-401161
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001862
Orphan claim re-pointed
Claims processor
CLM-420984 → UHC-75457-07 (Emily Owens)
Member id
UHC-75457-07
Confidence
1
Method
probabilistic
MBR-019813CLM-420984
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001863
Orphan claim re-pointed
Claims processor
CLM-423811 → UHC-01960-86 (Cynthia Castro)
Member id
UHC-01960-86
Confidence
1
Method
probabilistic
MBR-020040CLM-423811
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001864
Orphan claim re-pointed
Claims processor
CLM-423356 → UHC-55513-50 (Aaron Aguilar)
Member id
UHC-55513-50
Confidence
1
Method
probabilistic
MBR-002940CLM-423356
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001865
Orphan claim re-pointed
Claims processor
CLM-419738 → UHC-37330-92 (Kathryn Day)
Member id
UHC-37330-92
Confidence
1
Method
probabilistic
MBR-021464CLM-419738
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001866
Orphan claim re-pointed
Claims processor
CLM-410185 → UHC-50173-29 (Sarah Crawford)
Member id
UHC-50173-29
Confidence
0.93
Method
probabilistic
MBR-023665CLM-410185
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001867
Orphan claim re-pointed
Claims processor
CLM-429040 → UHC-34224-49 (Mei Thompson)
Member id
UHC-34224-49
Confidence
0.97
Method
deterministic
MBR-044277CLM-429040
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001868
Orphan claim re-pointed
Claims processor
CLM-403320 → UHC-16432-60 (Steven Fox)
Member id
UHC-16432-60
Confidence
0.97
Method
deterministic
MBR-025061CLM-403320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001869
Orphan claim re-pointed
Claims processor
CLM-416105 → UHC-44697-32 (Jon Oliver)
Member id
UHC-44697-32
Confidence
1
Method
probabilistic
MBR-005895CLM-416105
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001870
Orphan claim re-pointed
Claims processor
CLM-421753 → UHC-84718-34 (Linda Johnson)
Member id
UHC-84718-34
Confidence
1
Method
probabilistic
MBR-032292CLM-421753
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001871
Orphan claim re-pointed
Claims processor
CLM-432184 → UHC-41395-61 (Madison Allen)
Member id
UHC-41395-61
Confidence
0.97
Method
deterministic
MBR-002931CLM-432184
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001872
Orphan claim re-pointed
Claims processor
CLM-404785 → UHC-44621-72 (Salazar Christian)
Member id
UHC-44621-72
Confidence
0.97
Method
probabilistic
MBR-005372CLM-404785
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001873
Orphan claim re-pointed
Claims processor
CLM-425051 → UHC-92395-20 (Charles Ortiz)
Member id
UHC-92395-20
Confidence
1
Method
probabilistic
MBR-005373CLM-425051
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001874
Orphan claim re-pointed
Claims processor
CLM-432304 → UHC-41143-37 (Kayla Valdez)
Member id
UHC-41143-37
Confidence
1
Method
probabilistic
MBR-004577CLM-432304
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001875
Orphan claim re-pointed
Claims processor
CLM-405084 → UHC-84948-25 (Judith Lopez)
Member id
UHC-84948-25
Confidence
1
Method
probabilistic
MBR-003221CLM-405084
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001876
Orphan claim re-pointed
Claims processor
CLM-417320 → UHC-81179-53 (Alexis Walker)
Member id
UHC-81179-53
Confidence
0.93
Method
probabilistic
MBR-016410CLM-417320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001877
Orphan claim re-pointed
Claims processor
CLM-401007 → UHC-31657-36 (Beverly Dominguez)
Member id
UHC-31657-36
Confidence
1
Method
probabilistic
MBR-024670CLM-401007
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001878
Orphan claim re-pointed
Claims processor
CLM-423818 → UHC-34539-08 (Yuki Johnson)
Member id
UHC-34539-08
Confidence
1
Method
probabilistic
MBR-014044CLM-423818
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001879
Orphan claim re-pointed
Claims processor
CLM-430421 → UHC-45196-98 (Dennis Nelson)
Member id
UHC-45196-98
Confidence
0.97
Method
deterministic
MBR-039578CLM-430421
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001880
Orphan claim re-pointed
Claims processor
CLM-422168 → UHC-96032-88 (Virginia Hawkins)
Member id
UHC-96032-88
Confidence
1
Method
probabilistic
MBR-020502CLM-422168
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001881
Orphan claim re-pointed
Claims processor
CLM-407394 → UHC-82109-72 (Madison Moreno)
Member id
UHC-82109-72
Confidence
0.99
Method
probabilistic
MBR-026520CLM-407394
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001882
Orphan claim re-pointed
Claims processor
CLM-413890 → UHC-46770-67 (Anthony Davis)
Member id
UHC-46770-67
Confidence
1
Method
probabilistic
MBR-011565CLM-413890
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001883
Orphan claim re-pointed
Claims processor
CLM-410231 → UHC-60881-82 (Paul Bryant)
Member id
UHC-60881-82
Confidence
0.99
Method
probabilistic
MBR-029355CLM-410231
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001884
Orphan claim re-pointed
Claims processor
CLM-411429 → UHC-94285-65 (Jeremy Holmes)
Member id
UHC-94285-65
Confidence
1
Method
probabilistic
MBR-019265CLM-411429
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001885
Orphan claim re-pointed
Claims processor
CLM-428000 → UHC-92037-28 (Daniel Gilbert)
Member id
UHC-92037-28
Confidence
1
Method
probabilistic
MBR-022826CLM-428000
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001886
Orphan claim re-pointed
Claims processor
CLM-407718 → UHC-21792-24 (Natalie Wallace)
Member id
UHC-21792-24
Confidence
1
Method
probabilistic
MBR-009462CLM-407718
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001887
Orphan claim re-pointed
Claims processor
CLM-426630 → UHC-62320-38 (Barbara Cooper)
Member id
UHC-62320-38
Confidence
1
Method
probabilistic
MBR-012284CLM-426630
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001888
Orphan claim re-pointed
Claims processor
CLM-405844 → UHC-70283-31 (Randy Reid)
Member id
UHC-70283-31
Confidence
1
Method
probabilistic
MBR-012652CLM-405844
Executed
resolution_agent
2026-10-22 12:47:23
ACT-001889
Orphan claim re-pointed
Claims processor
CLM-411777 → UHC-43485-07 (Laura Ruiz)
Member id
UHC-43485-07
Confidence
0.93
Method
probabilistic
MBR-001748CLM-411777
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 11 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.