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-007040
Orphan claim re-pointed
Claims processor
CLM-402787 → UHC-03439-03 (Luis Wallace)
Member id
UHC-03439-03
Confidence
1
Method
probabilistic
MBR-010455CLM-402787
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007041
Orphan claim re-pointed
Claims processor
CLM-425184 → UHC-46251-68 (Deborah Lynch)
Member id
UHC-46251-68
Confidence
0.97
Method
deterministic
MBR-007083CLM-425184
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007042
Orphan claim re-pointed
Claims processor
CLM-419971 → UHC-60192-48 (Emma Gardner)
Member id
UHC-60192-48
Confidence
0.99
Method
probabilistic
MBR-020632CLM-419971
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007043
Orphan claim re-pointed
Claims processor
CLM-421263 → UHC-68395-91 (Randy Lawrence)
Member id
UHC-68395-91
Confidence
1
Method
probabilistic
MBR-012482CLM-421263
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007044
Orphan claim re-pointed
Claims processor
CLM-416810 → UHC-33256-68 (Peter Gray)
Member id
UHC-33256-68
Confidence
1
Method
probabilistic
MBR-017680CLM-416810
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007045
Orphan claim re-pointed
Claims processor
CLM-428799 → UHC-60979-31 (Russell Weaver)
Member id
UHC-60979-31
Confidence
0.98
Method
probabilistic
MBR-007664CLM-428799
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007046
Orphan claim re-pointed
Claims processor
CLM-402549 → UHC-77309-19 (Diana Hernandez)
Member id
UHC-77309-19
Confidence
1
Method
probabilistic
MBR-043348CLM-402549
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007047
Orphan claim re-pointed
Claims processor
CLM-415099 → UHC-19125-53 (Emily Lane)
Member id
UHC-19125-53
Confidence
0.94
Method
probabilistic
MBR-033908CLM-415099
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007048
Orphan claim re-pointed
Claims processor
CLM-401986 → UHC-73453-17 (Stephanie Berry)
Member id
UHC-73453-17
Confidence
1
Method
probabilistic
MBR-031903CLM-401986
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007049
Orphan claim re-pointed
Claims processor
CLM-406660 → UHC-51288-35 (Joyce Perry)
Member id
UHC-51288-35
Confidence
0.97
Method
deterministic
MBR-029317CLM-406660
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007050
Orphan claim re-pointed
Claims processor
CLM-418445 → UHC-87872-07 (Martha Gonzales)
Member id
UHC-87872-07
Confidence
1
Method
probabilistic
MBR-021994CLM-418445
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007051
Orphan claim re-pointed
Claims processor
CLM-426642 → UHC-93715-49 (Nancy Richards)
Member id
UHC-93715-49
Confidence
1
Method
probabilistic
MBR-011033CLM-426642
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007052
Orphan claim re-pointed
Claims processor
CLM-408588 → UHC-19807-30 (Joshua Gordon)
Member id
UHC-19807-30
Confidence
1
Method
probabilistic
MBR-027087CLM-408588
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007053
Orphan claim re-pointed
Claims processor
CLM-409381 → UHC-22854-38 (Anna Carlson)
Member id
UHC-22854-38
Confidence
1
Method
probabilistic
MBR-005477CLM-409381
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007054
Orphan claim re-pointed
Claims processor
CLM-409308 → UHC-85666-65 (Wayne Arnold)
Member id
UHC-85666-65
Confidence
1
Method
probabilistic
MBR-023371CLM-409308
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007055
Orphan claim re-pointed
Claims processor
CLM-414413 → UHC-35265-34 (Bobby Sandoval)
Member id
UHC-35265-34
Confidence
1
Method
probabilistic
MBR-016676CLM-414413
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007056
Orphan claim re-pointed
Claims processor
CLM-402596 → UHC-52002-05 (Patricia Graham)
Member id
UHC-52002-05
Confidence
0.97
Method
deterministic
MBR-000440CLM-402596
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007057
Orphan claim re-pointed
Claims processor
CLM-420318 → UHC-91446-36 (Gary Torres)
Member id
UHC-91446-36
Confidence
0.99
Method
probabilistic
MBR-002784CLM-420318
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007058
Orphan claim re-pointed
Claims processor
CLM-415036 → UHC-43336-64 (Keith Fox)
Member id
UHC-43336-64
Confidence
0.97
Method
deterministic
MBR-033747CLM-415036
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007059
Orphan claim re-pointed
Claims processor
CLM-432296 → UHC-89122-31 (David Howell)
Member id
UHC-89122-31
Confidence
0.99
Method
probabilistic
MBR-025429CLM-432296
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007060
Orphan claim re-pointed
Claims processor
CLM-419341 → UHC-94105-73 (Richard Boyd)
Member id
UHC-94105-73
Confidence
1
Method
probabilistic
MBR-004511CLM-419341
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007061
Orphan claim re-pointed
Claims processor
CLM-402751 → UHC-75257-74 (George Knight)
Member id
UHC-75257-74
Confidence
1
Method
probabilistic
MBR-001992CLM-402751
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007062
Orphan claim re-pointed
Claims processor
CLM-425358 → UHC-45106-07 (Nathan Patterson)
Member id
UHC-45106-07
Confidence
1
Method
probabilistic
MBR-012916CLM-425358
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007063
Orphan claim re-pointed
Claims processor
CLM-429485 → UHC-15796-58 (Stephen King)
Member id
UHC-15796-58
Confidence
1
Method
probabilistic
MBR-002628CLM-429485
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007064
Orphan claim re-pointed
Claims processor
CLM-412331 → UHC-02947-44 (Carolyn Garrett)
Member id
UHC-02947-44
Confidence
0.97
Method
deterministic
MBR-013924CLM-412331
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007065
Orphan claim re-pointed
Claims processor
CLM-418154 → UHC-63645-91 (Harold Mejia)
Member id
UHC-63645-91
Confidence
1
Method
probabilistic
MBR-009130CLM-418154
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007066
Orphan claim re-pointed
Claims processor
CLM-407420 → UHC-15937-04 (Rachel Munoz)
Member id
UHC-15937-04
Confidence
1
Method
probabilistic
MBR-009939CLM-407420
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007067
Orphan claim re-pointed
Claims processor
CLM-409307 → UHC-30271-36 (Emma Estrada)
Member id
UHC-30271-36
Confidence
1
Method
probabilistic
MBR-006207CLM-409307
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007068
Orphan claim re-pointed
Claims processor
CLM-421358 → UHC-19063-42 (Larry Bradley)
Member id
UHC-19063-42
Confidence
0.99
Method
probabilistic
MBR-038211CLM-421358
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007069
Orphan claim re-pointed
Claims processor
CLM-412428 → UHC-62361-29 (Jason Wang)
Member id
UHC-62361-29
Confidence
1
Method
probabilistic
MBR-025813CLM-412428
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007070
Orphan claim re-pointed
Claims processor
CLM-421703 → UHC-25714-67 (Paul Bryant)
Member id
UHC-25714-67
Confidence
0.93
Method
probabilistic
MBR-019832CLM-421703
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007071
Orphan claim re-pointed
Claims processor
CLM-425859 → UHC-68692-18 (Donna Reed)
Member id
UHC-68692-18
Confidence
1
Method
probabilistic
MBR-001647CLM-425859
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007072
Orphan claim re-pointed
Claims processor
CLM-428032 → UHC-28017-01 (Lawrence Johnston)
Member id
UHC-28017-01
Confidence
1
Method
probabilistic
MBR-022857CLM-428032
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007073
Orphan claim re-pointed
Claims processor
CLM-411399 → UHC-75380-43 (Julie Ortega)
Member id
UHC-75380-43
Confidence
0.93
Method
probabilistic
MBR-019990CLM-411399
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007074
Orphan claim re-pointed
Claims processor
CLM-414702 → UHC-66762-67 (Cynthia Green)
Member id
UHC-66762-67
Confidence
1.00
Method
probabilistic
MBR-011352CLM-414702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007075
Orphan claim re-pointed
Claims processor
CLM-406650 → UHC-76743-89 (Walter Patel)
Member id
UHC-76743-89
Confidence
1
Method
probabilistic
MBR-026737CLM-406650
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007076
Orphan claim re-pointed
Claims processor
CLM-405020 → UHC-26434-29 (Abigail George)
Member id
UHC-26434-29
Confidence
1
Method
probabilistic
MBR-007370CLM-405020
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007077
Orphan claim re-pointed
Claims processor
CLM-401399 → UHC-65311-64 (Gabriel Robertson)
Member id
UHC-65311-64
Confidence
1
Method
probabilistic
MBR-001760CLM-401399
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007078
Orphan claim re-pointed
Claims processor
CLM-427932 → UHC-47608-49 (Jack Taylor)
Member id
UHC-47608-49
Confidence
0.97
Method
deterministic
MBR-025980CLM-427932
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007079
Orphan claim re-pointed
Claims processor
CLM-408629 → UHC-11208-80 (Theresa Munoz)
Member id
UHC-11208-80
Confidence
1
Method
probabilistic
MBR-004379CLM-408629
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007080
Orphan claim re-pointed
Claims processor
CLM-405392 → UHC-81436-54 (Wei Martinez)
Member id
UHC-81436-54
Confidence
0.97
Method
deterministic
MBR-006095CLM-405392
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007081
Orphan claim re-pointed
Claims processor
CLM-420510 → UHC-80101-02 (Arjun White)
Member id
UHC-80101-02
Confidence
0.98
Method
probabilistic
MBR-008780CLM-420510
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007082
Orphan claim re-pointed
Claims processor
CLM-410241 → UHC-81933-20 (Scott Lynch)
Member id
UHC-81933-20
Confidence
1
Method
probabilistic
MBR-032627CLM-410241
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007083
Orphan claim re-pointed
Claims processor
CLM-420576 → UHC-73258-28 (Willie Daniels)
Member id
UHC-73258-28
Confidence
1
Method
probabilistic
MBR-008733CLM-420576
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007084
Orphan claim re-pointed
Claims processor
CLM-432321 → UHC-58364-11 (Cheryl Obrien)
Member id
UHC-58364-11
Confidence
0.99
Method
probabilistic
MBR-002556CLM-432321
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007085
Orphan claim re-pointed
Claims processor
CLM-417848 → UHC-78224-40 (Sean Castro)
Member id
UHC-78224-40
Confidence
0.94
Method
probabilistic
MBR-001542CLM-417848
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007086
Orphan claim re-pointed
Claims processor
CLM-418734 → UHC-20070-18 (Justin Martinez)
Member id
UHC-20070-18
Confidence
1
Method
probabilistic
MBR-010191CLM-418734
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007087
Orphan claim re-pointed
Claims processor
CLM-408973 → UHC-27676-63 (Nicole Sullivan)
Member id
UHC-27676-63
Confidence
0.97
Method
deterministic
MBR-029876CLM-408973
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007088
Orphan claim re-pointed
Claims processor
CLM-409737 → UHC-80139-48 (Scott Howell)
Member id
UHC-80139-48
Confidence
1
Method
probabilistic
MBR-019713CLM-409737
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007089
Orphan claim re-pointed
Claims processor
CLM-408767 → UHC-60553-01 (Amy Young)
Member id
UHC-60553-01
Confidence
1
Method
probabilistic
MBR-008531CLM-408767
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 115 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.