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-006840
Orphan claim re-pointed
Claims processor
CLM-405666 → UHC-41947-43 (Jacqueline Fowler)
Member id
UHC-41947-43
Confidence
1
Method
probabilistic
MBR-037989CLM-405666
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006841
Orphan claim re-pointed
Claims processor
CLM-428515 → UHC-64089-39 (Randy Carpenter)
Member id
UHC-64089-39
Confidence
0.97
Method
deterministic
MBR-024291CLM-428515
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006842
Orphan claim re-pointed
Claims processor
CLM-408212 → UHC-87272-66 (Billy Olson)
Member id
UHC-87272-66
Confidence
0.97
Method
deterministic
MBR-030613CLM-408212
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006843
Orphan claim re-pointed
Claims processor
CLM-431542 → UHC-37191-05 (Patricia Parker)
Member id
UHC-37191-05
Confidence
1
Method
probabilistic
MBR-006359CLM-431542
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006844
Orphan claim re-pointed
Claims processor
CLM-427017 → UHC-68219-53 (Richard James)
Member id
UHC-68219-53
Confidence
1
Method
probabilistic
MBR-041408CLM-427017
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006845
Orphan claim re-pointed
Claims processor
CLM-430506 → UHC-78632-10 (Kevin Andrews)
Member id
UHC-78632-10
Confidence
1
Method
probabilistic
MBR-023694CLM-430506
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006846
Orphan claim re-pointed
Claims processor
CLM-416242 → UHC-99638-54 (Mei Espinoza)
Member id
UHC-99638-54
Confidence
1
Method
probabilistic
MBR-022461CLM-416242
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006847
Orphan claim re-pointed
Claims processor
CLM-413243 → UHC-86246-70 (Roy Patel)
Member id
UHC-86246-70
Confidence
1
Method
probabilistic
MBR-031127CLM-413243
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006848
Orphan claim re-pointed
Claims processor
CLM-400313 → UHC-79984-33 (Cynthia Harris)
Member id
UHC-79984-33
Confidence
0.97
Method
deterministic
MBR-023807CLM-400313
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006849
Orphan claim re-pointed
Claims processor
CLM-412420 → UHC-94691-18 (Robetr Perkins)
Member id
UHC-94691-18
Confidence
1.00
Method
probabilistic
MBR-029758CLM-412420
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006850
Orphan claim re-pointed
Claims processor
CLM-405528 → UHC-66614-26 (Denise Dunn)
Member id
UHC-66614-26
Confidence
1
Method
probabilistic
MBR-009332CLM-405528
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006851
Orphan claim re-pointed
Claims processor
CLM-403849 → UHC-15592-78 (Catherine Richardson)
Member id
UHC-15592-78
Confidence
1
Method
probabilistic
MBR-033724CLM-403849
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006852
Orphan claim re-pointed
Claims processor
CLM-423289 → UHC-25477-10 (Richard Hansen)
Member id
UHC-25477-10
Confidence
0.98
Method
probabilistic
MBR-011482CLM-423289
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006853
Orphan claim re-pointed
Claims processor
CLM-409311 → UHC-30817-37 (Cheryl Kelly)
Member id
UHC-30817-37
Confidence
1
Method
probabilistic
MBR-005201CLM-409311
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006854
Orphan claim re-pointed
Claims processor
CLM-401398 → UHC-52766-32 (Bryan Cruz)
Member id
UHC-52766-32
Confidence
0.99
Method
probabilistic
MBR-022990CLM-401398
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006855
Orphan claim re-pointed
Claims processor
CLM-428111 → UHC-11981-05 (Zachary Scott)
Member id
UHC-11981-05
Confidence
0.97
Method
deterministic
MBR-026946CLM-428111
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006856
Orphan claim re-pointed
Claims processor
CLM-425306 → UHC-91873-66 (Rebecca Burke)
Member id
UHC-91873-66
Confidence
1
Method
probabilistic
MBR-025473CLM-425306
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006857
Orphan claim re-pointed
Claims processor
CLM-404758 → UHC-74232-48 (Nancy Elliott)
Member id
UHC-74232-48
Confidence
1
Method
probabilistic
MBR-021019CLM-404758
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006858
Orphan claim re-pointed
Claims processor
CLM-414336 → UHC-74680-11 (Lucia Welch)
Member id
UHC-74680-11
Confidence
1
Method
probabilistic
MBR-015037CLM-414336
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006859
Orphan claim re-pointed
Claims processor
CLM-414071 → UHC-72265-16 (Michael Lucas)
Member id
UHC-72265-16
Confidence
1
Method
probabilistic
MBR-020647CLM-414071
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006860
Orphan claim re-pointed
Claims processor
CLM-418634 → UHC-44752-52 (Abigail Harrison)
Member id
UHC-44752-52
Confidence
1
Method
probabilistic
MBR-037426CLM-418634
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006861
Orphan claim re-pointed
Claims processor
CLM-414751 → UHC-13601-93 (Juan Lopez)
Member id
UHC-13601-93
Confidence
1
Method
probabilistic
MBR-012669CLM-414751
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006862
Orphan claim re-pointed
Claims processor
CLM-403394 → UHC-81347-87 (Jason Stone)
Member id
UHC-81347-87
Confidence
1
Method
probabilistic
MBR-014332CLM-403394
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006863
Orphan claim re-pointed
Claims processor
CLM-400640 → UHC-33970-88 (Billy Jacobs)
Member id
UHC-33970-88
Confidence
1
Method
probabilistic
MBR-012421CLM-400640
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006864
Orphan claim re-pointed
Claims processor
CLM-422207 → UHC-02360-93 (Sara Carpenter)
Member id
UHC-02360-93
Confidence
1
Method
probabilistic
MBR-012492CLM-422207
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006865
Orphan claim re-pointed
Claims processor
CLM-407928 → UHC-87372-54 (Jeremy Reyes)
Member id
UHC-87372-54
Confidence
1
Method
probabilistic
MBR-003804CLM-407928
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006866
Orphan claim re-pointed
Claims processor
CLM-426332 → UHC-70642-29 (Nancy Fields)
Member id
UHC-70642-29
Confidence
1
Method
probabilistic
MBR-024707CLM-426332
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006867
Orphan claim re-pointed
Claims processor
CLM-404211 → UHC-66823-60 (Jeremy Campbell)
Member id
UHC-66823-60
Confidence
1
Method
probabilistic
MBR-038245CLM-404211
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006868
Orphan claim re-pointed
Claims processor
CLM-409608 → UHC-52959-32 (Paul Webb)
Member id
UHC-52959-32
Confidence
0.97
Method
deterministic
MBR-029167CLM-409608
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006869
Orphan claim re-pointed
Claims processor
CLM-409565 → UHC-76252-18 (Linda Parker)
Member id
UHC-76252-18
Confidence
1
Method
probabilistic
MBR-002338CLM-409565
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006870
Orphan claim re-pointed
Claims processor
CLM-416390 → UHC-94650-89 (Eric Schmidt)
Member id
UHC-94650-89
Confidence
1
Method
probabilistic
MBR-005264CLM-416390
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006871
Orphan claim re-pointed
Claims processor
CLM-415484 → UHC-67722-09 (Gabriel Davis)
Member id
UHC-67722-09
Confidence
1
Method
probabilistic
MBR-017679CLM-415484
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006872
Orphan claim re-pointed
Claims processor
CLM-405409 → UHC-63626-44 (Diego Bradley)
Member id
UHC-63626-44
Confidence
0.99
Method
probabilistic
MBR-017284CLM-405409
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006873
Orphan claim re-pointed
Claims processor
CLM-429739 → UHC-66691-05 (Austin Nguyen)
Member id
UHC-66691-05
Confidence
1
Method
probabilistic
MBR-013844CLM-429739
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006874
Orphan claim re-pointed
Claims processor
CLM-412795 → UHC-33252-10 (Juan Carpenter)
Member id
UHC-33252-10
Confidence
1
Method
probabilistic
MBR-019209CLM-412795
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006875
Orphan claim re-pointed
Claims processor
CLM-418423 → UHC-24398-42 (Camila Sanders)
Member id
UHC-24398-42
Confidence
1
Method
probabilistic
MBR-008496CLM-418423
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006876
Orphan claim re-pointed
Claims processor
CLM-405987 → UHC-04821-42 (Deborah Vasquez)
Member id
UHC-04821-42
Confidence
1
Method
probabilistic
MBR-023279CLM-405987
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006877
Orphan claim re-pointed
Claims processor
CLM-402540 → UHC-33344-70 (James Delgado)
Member id
UHC-33344-70
Confidence
1
Method
probabilistic
MBR-018511CLM-402540
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006878
Orphan claim re-pointed
Claims processor
CLM-422269 → UHC-90693-56 (Roger Peters)
Member id
UHC-90693-56
Confidence
1
Method
probabilistic
MBR-027123CLM-422269
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006879
Orphan claim re-pointed
Claims processor
CLM-427824 → UHC-64152-85 (Donna Ramos)
Member id
UHC-64152-85
Confidence
1
Method
probabilistic
MBR-027937CLM-427824
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006880
Orphan claim re-pointed
Claims processor
CLM-428921 → UHC-70467-12 (Andrea Griffin)
Member id
UHC-70467-12
Confidence
1
Method
probabilistic
MBR-017785CLM-428921
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006881
Orphan claim re-pointed
Claims processor
CLM-414117 → UHC-48894-38 (Dennis Spencer)
Member id
UHC-48894-38
Confidence
0.97
Method
deterministic
MBR-000087CLM-414117
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006882
Orphan claim re-pointed
Claims processor
CLM-430411 → UHC-37517-47 (Bradley Larson)
Member id
UHC-37517-47
Confidence
1
Method
probabilistic
MBR-013945CLM-430411
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006883
Orphan claim re-pointed
Claims processor
CLM-421405 → UHC-02720-67 (Santiago Fields)
Member id
UHC-02720-67
Confidence
1
Method
probabilistic
MBR-018872CLM-421405
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006884
Orphan claim re-pointed
Claims processor
CLM-416919 → UHC-12402-61 (Thomas Chapman)
Member id
UHC-12402-61
Confidence
1
Method
probabilistic
MBR-008014CLM-416919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006885
Orphan claim re-pointed
Claims processor
CLM-429877 → UHC-41015-83 (Luis Stevens)
Member id
UHC-41015-83
Confidence
1
Method
probabilistic
MBR-024946CLM-429877
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006886
Orphan claim re-pointed
Claims processor
CLM-415644 → UHC-23041-70 (Austin Johnson)
Member id
UHC-23041-70
Confidence
1
Method
probabilistic
MBR-004367CLM-415644
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006887
Orphan claim re-pointed
Claims processor
CLM-403738 → UHC-15167-50 (Gerald Cunningham)
Member id
UHC-15167-50
Confidence
1
Method
probabilistic
MBR-002081CLM-403738
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006888
Orphan claim re-pointed
Claims processor
CLM-431072 → UHC-00720-73 (Brenda Carpenter)
Member id
UHC-00720-73
Confidence
1
Method
probabilistic
MBR-025314CLM-431072
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006889
Orphan claim re-pointed
Claims processor
CLM-413354 → UHC-95825-79 (Bruce Murray)
Member id
UHC-95825-79
Confidence
1
Method
probabilistic
MBR-001690CLM-413354
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 111 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.