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-006990
Orphan claim re-pointed
Claims processor
CLM-412710 → UHC-17679-69 (Randy Dixon)
Member id
UHC-17679-69
Confidence
0.99
Method
probabilistic
MBR-019683CLM-412710
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006991
Orphan claim re-pointed
Claims processor
CLM-408484 → UHC-71172-51 (Ralph Johnston)
Member id
UHC-71172-51
Confidence
1
Method
probabilistic
MBR-011558CLM-408484
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006992
Orphan claim re-pointed
Claims processor
CLM-427642 → UHC-57924-01 (Shirley Simpson)
Member id
UHC-57924-01
Confidence
0.93
Method
probabilistic
MBR-017444CLM-427642
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006993
Orphan claim re-pointed
Claims processor
CLM-413166 → UHC-58593-18 (Logan Phillips)
Member id
UHC-58593-18
Confidence
1
Method
probabilistic
MBR-010813CLM-413166
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006994
Orphan claim re-pointed
Claims processor
CLM-413264 → UHC-95705-04 (Willie Hicks)
Member id
UHC-95705-04
Confidence
0.97
Method
deterministic
MBR-013351CLM-413264
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006995
Orphan claim re-pointed
Claims processor
CLM-417943 → UHC-87700-61 (Ryan Rogers)
Member id
UHC-87700-61
Confidence
1
Method
probabilistic
MBR-002075CLM-417943
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006996
Orphan claim re-pointed
Claims processor
CLM-418823 → UHC-20624-46 (Bruce Nichols)
Member id
UHC-20624-46
Confidence
1
Method
probabilistic
MBR-017833CLM-418823
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006997
Orphan claim re-pointed
Claims processor
CLM-404491 → UHC-32520-91 (Jonathan Cunningham)
Member id
UHC-32520-91
Confidence
1
Method
probabilistic
MBR-005389CLM-404491
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006998
Orphan claim re-pointed
Claims processor
CLM-428516 → UHC-40621-41 (Scott Chapman)
Member id
UHC-40621-41
Confidence
0.97
Method
deterministic
MBR-036737CLM-428516
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006999
Orphan claim re-pointed
Claims processor
CLM-400763 → UHC-23266-84 (Billy Thomas)
Member id
UHC-23266-84
Confidence
1
Method
probabilistic
MBR-021224CLM-400763
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007000
Orphan claim re-pointed
Claims processor
CLM-428466 → UHC-22551-06 (Laura Hill)
Member id
UHC-22551-06
Confidence
0.87
Method
probabilistic
MBR-003322CLM-428466
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007001
Orphan claim re-pointed
Claims processor
CLM-421466 → UHC-09837-69 (Karen Foster)
Member id
UHC-09837-69
Confidence
1
Method
probabilistic
MBR-000741CLM-421466
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007002
Orphan claim re-pointed
Claims processor
CLM-411577 → UHC-86063-13 (Ahmed Patel)
Member id
UHC-86063-13
Confidence
1
Method
probabilistic
MBR-024580CLM-411577
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007003
Orphan claim re-pointed
Claims processor
CLM-422494 → UHC-43524-49 (Rachel Lopez)
Member id
UHC-43524-49
Confidence
1
Method
probabilistic
MBR-005146CLM-422494
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007004
Orphan claim re-pointed
Claims processor
CLM-426052 → UHC-95033-99 (Carlos Estrada)
Member id
UHC-95033-99
Confidence
1
Method
probabilistic
MBR-024709CLM-426052
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007005
Orphan claim re-pointed
Claims processor
CLM-431195 → UHC-46380-98 (Timothy Long)
Member id
UHC-46380-98
Confidence
1
Method
probabilistic
MBR-024837CLM-431195
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007006
Orphan claim re-pointed
Claims processor
CLM-419900 → UHC-69124-67 (Kathryn Robinson)
Member id
UHC-69124-67
Confidence
1
Method
probabilistic
MBR-003509CLM-419900
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007007
Orphan claim re-pointed
Claims processor
CLM-427994 → UHC-68499-83 (Jose Williams)
Member id
UHC-68499-83
Confidence
1
Method
probabilistic
MBR-012275CLM-427994
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007008
Orphan claim re-pointed
Claims processor
CLM-427157 → UHC-26241-69 (Donald Henry)
Member id
UHC-26241-69
Confidence
1
Method
probabilistic
MBR-026779CLM-427157
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007009
Orphan claim re-pointed
Claims processor
CLM-412042 → UHC-26200-71 (Jonathan McDonald)
Member id
UHC-26200-71
Confidence
1
Method
probabilistic
MBR-020275CLM-412042
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007010
Orphan claim re-pointed
Claims processor
CLM-424416 → UHC-85600-23 (Noah Cooper)
Member id
UHC-85600-23
Confidence
1
Method
probabilistic
MBR-019191CLM-424416
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007011
Orphan claim re-pointed
Claims processor
CLM-400211 → UHC-96143-73 (Brandon Bennett)
Member id
UHC-96143-73
Confidence
1
Method
probabilistic
MBR-012428CLM-400211
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007012
Orphan claim re-pointed
Claims processor
CLM-422151 → UHC-85301-17 (Jason Espinoza)
Member id
UHC-85301-17
Confidence
1
Method
probabilistic
MBR-006148CLM-422151
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007013
Orphan claim re-pointed
Claims processor
CLM-410870 → UHC-84632-41 (Gerald Bennett)
Member id
UHC-84632-41
Confidence
1
Method
probabilistic
MBR-041848CLM-410870
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007014
Orphan claim re-pointed
Claims processor
CLM-400362 → UHC-69655-07 (Eric Sims)
Member id
UHC-69655-07
Confidence
1
Method
probabilistic
MBR-019406CLM-400362
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007015
Orphan claim re-pointed
Claims processor
CLM-429931 → UHC-43150-75 (Amy Carr)
Member id
UHC-43150-75
Confidence
1
Method
probabilistic
MBR-015811CLM-429931
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007016
Orphan claim re-pointed
Claims processor
CLM-406496 → UHC-54871-91 (Omar Torres)
Member id
UHC-54871-91
Confidence
0.97
Method
deterministic
MBR-024385CLM-406496
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007017
Orphan claim re-pointed
Claims processor
CLM-429483 → UHC-15796-58 (Stephen King)
Member id
UHC-15796-58
Confidence
0.88
Method
probabilistic
MBR-002628CLM-429483
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007018
Orphan claim re-pointed
Claims processor
CLM-420116 → UHC-36493-03 (Jose Mejia)
Member id
UHC-36493-03
Confidence
1
Method
probabilistic
MBR-001214CLM-420116
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007019
Orphan claim re-pointed
Claims processor
CLM-420487 → UHC-68721-38 (Jose Kennedy)
Member id
UHC-68721-38
Confidence
1
Method
probabilistic
MBR-003034CLM-420487
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007020
Orphan claim re-pointed
Claims processor
CLM-423708 → UHC-22282-57 (Joyce Montgomery)
Member id
UHC-22282-57
Confidence
1
Method
probabilistic
MBR-019420CLM-423708
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007021
Orphan claim re-pointed
Claims processor
CLM-432161 → UHC-59494-89 (Linda Reid)
Member id
UHC-59494-89
Confidence
0.99
Method
probabilistic
MBR-034318CLM-432161
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007022
Orphan claim re-pointed
Claims processor
CLM-424666 → UHC-60560-81 (Alice Mejia)
Member id
UHC-60560-81
Confidence
1
Method
probabilistic
MBR-030620CLM-424666
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007023
Orphan claim re-pointed
Claims processor
CLM-409977 → UHC-24326-31 (Priya Dixon)
Member id
UHC-24326-31
Confidence
1
Method
probabilistic
MBR-016593CLM-409977
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007024
Orphan claim re-pointed
Claims processor
CLM-405234 → UHC-52836-55 (Victoria Hawkins)
Member id
UHC-52836-55
Confidence
0.97
Method
deterministic
MBR-018388CLM-405234
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007025
Orphan claim re-pointed
Claims processor
CLM-406464 → UHC-73695-03 (Kathleen Moore)
Member id
UHC-73695-03
Confidence
1
Method
probabilistic
MBR-039191CLM-406464
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007026
Orphan claim re-pointed
Claims processor
CLM-413126 → UHC-33748-51 (Frank Howard)
Member id
UHC-33748-51
Confidence
1
Method
probabilistic
MBR-019927CLM-413126
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007027
Orphan claim re-pointed
Claims processor
CLM-404649 → UHC-13806-99 (Mary Wilson)
Member id
UHC-13806-99
Confidence
1
Method
probabilistic
MBR-029755CLM-404649
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007028
Orphan claim re-pointed
Claims processor
CLM-422135 → UHC-73040-31 (Kevin Reynolds)
Member id
UHC-73040-31
Confidence
1
Method
probabilistic
MBR-022639CLM-422135
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007029
Orphan claim re-pointed
Claims processor
CLM-421764 → UHC-69098-58 (Laura Bennett)
Member id
UHC-69098-58
Confidence
1
Method
probabilistic
MBR-016031CLM-421764
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007030
Orphan claim re-pointed
Claims processor
CLM-421966 → UHC-17502-07 (Jeffrey Harrison)
Member id
UHC-17502-07
Confidence
1
Method
probabilistic
MBR-003965CLM-421966
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007031
Orphan claim re-pointed
Claims processor
CLM-409139 → UHC-74963-28 (Bruce Adams)
Member id
UHC-74963-28
Confidence
0.97
Method
deterministic
MBR-016420CLM-409139
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007032
Orphan claim re-pointed
Claims processor
CLM-413910 → UHC-66169-12 (Paul Knight)
Member id
UHC-66169-12
Confidence
0.97
Method
deterministic
MBR-029438CLM-413910
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007033
Orphan claim re-pointed
Claims processor
CLM-420616 → UHC-01722-15 (Jonathan Snyder)
Member id
UHC-01722-15
Confidence
1
Method
probabilistic
MBR-011576CLM-420616
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007034
Orphan claim re-pointed
Claims processor
CLM-418915 → UHC-07852-29 (Stephanie Lee)
Member id
UHC-07852-29
Confidence
0.97
Method
deterministic
MBR-030726CLM-418915
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007035
Orphan claim re-pointed
Claims processor
CLM-420108 → UHC-36357-55 (Nicholas Hughes)
Member id
UHC-36357-55
Confidence
1
Method
probabilistic
MBR-015127CLM-420108
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007036
Orphan claim re-pointed
Claims processor
CLM-406741 → UHC-82015-88 (Ana Rojas)
Member id
UHC-82015-88
Confidence
1
Method
probabilistic
MBR-043730CLM-406741
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007037
Orphan claim re-pointed
Claims processor
CLM-413260 → UHC-23765-47 (Karen Morrison)
Member id
UHC-23765-47
Confidence
0.98
Method
probabilistic
MBR-034256CLM-413260
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007038
Orphan claim re-pointed
Claims processor
CLM-419707 → UHC-34608-53 (Marilyn James)
Member id
UHC-34608-53
Confidence
1
Method
probabilistic
MBR-002431CLM-419707
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007039
Orphan claim re-pointed
Claims processor
CLM-422054 → UHC-47146-64 (Sara Williams)
Member id
UHC-47146-64
Confidence
0.99
Method
probabilistic
MBR-034801CLM-422054
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 114 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.