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-008140
Orphan claim re-pointed
Claims processor
CLM-423877 → UHC-01003-36 (Joshua Burke)
Member id
UHC-01003-36
Confidence
0.97
Method
deterministic
MBR-012432CLM-423877
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008141
Orphan claim re-pointed
Claims processor
CLM-428303 → UHC-42987-12 (Brittany Moore)
Member id
UHC-42987-12
Confidence
1
Method
probabilistic
MBR-016035CLM-428303
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008142
Orphan claim re-pointed
Claims processor
CLM-410420 → UHC-92906-33 (Sara Campbell)
Member id
UHC-92906-33
Confidence
1
Method
probabilistic
MBR-029905CLM-410420
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008143
Orphan claim re-pointed
Claims processor
CLM-408625 → UHC-26618-68 (Betty Le)
Member id
UHC-26618-68
Confidence
1
Method
probabilistic
MBR-019709CLM-408625
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008144
Orphan claim re-pointed
Claims processor
CLM-415804 → UHC-94480-70 (Mary Miller)
Member id
UHC-94480-70
Confidence
0.97
Method
deterministic
MBR-015305CLM-415804
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008145
Orphan claim re-pointed
Claims processor
CLM-420167 → UHC-88779-73 (Sue Brown)
Member id
UHC-88779-73
Confidence
0.97
Method
deterministic
MBR-038497CLM-420167
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008146
Orphan claim re-pointed
Claims processor
CLM-420230 → UHC-78016-26 (Lawrence Welch)
Member id
UHC-78016-26
Confidence
1
Method
probabilistic
MBR-003599CLM-420230
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008147
Orphan claim re-pointed
Claims processor
CLM-421985 → UHC-15116-96 (Jesse Balck)
Member id
UHC-15116-96
Confidence
0.97
Method
deterministic
MBR-025179CLM-421985
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008148
Orphan claim re-pointed
Claims processor
CLM-405355 → UHC-77760-37 (Sophia Hughes)
Member id
UHC-77760-37
Confidence
1
Method
probabilistic
MBR-001505CLM-405355
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008149
Orphan claim re-pointed
Claims processor
CLM-400468 → UHC-43822-84 (Virginia Gibson)
Member id
UHC-43822-84
Confidence
1.00
Method
probabilistic
MBR-002860CLM-400468
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008150
Orphan claim re-pointed
Claims processor
CLM-424657 → UHC-91228-72 (Frank Washington)
Member id
UHC-91228-72
Confidence
0.97
Method
deterministic
MBR-005739CLM-424657
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008151
Orphan claim re-pointed
Claims processor
CLM-430211 → UHC-63930-87 (Alan Gilbert)
Member id
UHC-63930-87
Confidence
1
Method
probabilistic
MBR-013809CLM-430211
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008152
Orphan claim re-pointed
Claims processor
CLM-426481 → UHC-87593-18 (Teresa Elliott)
Member id
UHC-87593-18
Confidence
1
Method
probabilistic
MBR-006896CLM-426481
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008153
Orphan claim re-pointed
Claims processor
CLM-428833 → UHC-76258-52 (Roger Ross)
Member id
UHC-76258-52
Confidence
0.97
Method
deterministic
MBR-022138CLM-428833
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008154
Orphan claim re-pointed
Claims processor
CLM-426674 → UHC-30099-24 (Carlos Sttewart)
Member id
UHC-30099-24
Confidence
0.97
Method
deterministic
MBR-006535CLM-426674
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008155
Orphan claim re-pointed
Claims processor
CLM-428398 → UHC-37392-76 (Heather Castillo)
Member id
UHC-37392-76
Confidence
1
Method
probabilistic
MBR-023236CLM-428398
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008156
Orphan claim re-pointed
Claims processor
CLM-415470 → UHC-23648-90 (Natalie Wilson)
Member id
UHC-23648-90
Confidence
1
Method
probabilistic
MBR-022273CLM-415470
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008157
Orphan claim re-pointed
Claims processor
CLM-408356 → UHC-50549-37 (Camila Lucas)
Member id
UHC-50549-37
Confidence
1
Method
probabilistic
MBR-000518CLM-408356
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008158
Orphan claim re-pointed
Claims processor
CLM-422897 → UHC-11424-61 (Jean Boyd)
Member id
UHC-11424-61
Confidence
1
Method
probabilistic
MBR-008297CLM-422897
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008159
Orphan claim re-pointed
Claims processor
CLM-428843 → UHC-67988-31 (Peter Valdez)
Member id
UHC-67988-31
Confidence
0.97
Method
deterministic
MBR-046111CLM-428843
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008160
Orphan claim re-pointed
Claims processor
CLM-429189 → UHC-54998-45 (Sara Gutierrez)
Member id
UHC-54998-45
Confidence
1
Method
probabilistic
MBR-026408CLM-429189
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008161
Orphan claim re-pointed
Claims processor
CLM-423403 → UHC-41069-52 (Carolyn Martin)
Member id
UHC-41069-52
Confidence
1
Method
probabilistic
MBR-025239CLM-423403
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008162
Orphan claim re-pointed
Claims processor
CLM-417875 → UHC-13108-98 (Madison Stephens)
Member id
UHC-13108-98
Confidence
1
Method
probabilistic
MBR-026307CLM-417875
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008163
Orphan claim re-pointed
Claims processor
CLM-424744 → UHC-06546-55 (Christine Le)
Member id
UHC-06546-55
Confidence
1
Method
probabilistic
MBR-010077CLM-424744
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008164
Orphan claim re-pointed
Claims processor
CLM-420522 → UHC-34094-33 (Judith Ford)
Member id
UHC-34094-33
Confidence
1
Method
probabilistic
MBR-000431CLM-420522
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008165
Orphan claim re-pointed
Claims processor
CLM-413644 → UHC-71517-82 (Lauren Hill)
Member id
UHC-71517-82
Confidence
1
Method
probabilistic
MBR-006426CLM-413644
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008166
Orphan claim re-pointed
Claims processor
CLM-407633 → UHC-51627-22 (Gregory Wagner)
Member id
UHC-51627-22
Confidence
0.99
Method
probabilistic
MBR-022674CLM-407633
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008167
Orphan claim re-pointed
Claims processor
CLM-406519 → UHC-19783-34 (Linda Myers)
Member id
UHC-19783-34
Confidence
1
Method
probabilistic
MBR-029428CLM-406519
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008168
Orphan claim re-pointed
Claims processor
CLM-421708 → UHC-09615-90 (Lauren Montgomery)
Member id
UHC-09615-90
Confidence
1
Method
probabilistic
MBR-009141CLM-421708
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008169
Orphan claim re-pointed
Claims processor
CLM-402941 → UHC-20249-57 (Patrick McDonald)
Member id
UHC-20249-57
Confidence
0.99
Method
probabilistic
MBR-007979CLM-402941
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008170
Orphan claim re-pointed
Claims processor
CLM-420887 → UHC-40188-10 (Diana Burns)
Member id
UHC-40188-10
Confidence
1
Method
probabilistic
MBR-028179CLM-420887
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008171
Orphan claim re-pointed
Claims processor
CLM-416563 → UHC-50426-10 (Margaret Tucker)
Member id
UHC-50426-10
Confidence
1
Method
probabilistic
MBR-021517CLM-416563
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008172
Orphan claim re-pointed
Claims processor
CLM-414218 → UHC-20492-19 (Andrew Hicks)
Member id
UHC-20492-19
Confidence
0.99
Method
probabilistic
MBR-019842CLM-414218
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008173
Orphan claim re-pointed
Claims processor
CLM-411317 → UHC-59588-79 (Betty Rojas)
Member id
UHC-59588-79
Confidence
1
Method
probabilistic
MBR-010963CLM-411317
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008174
Orphan claim re-pointed
Claims processor
CLM-407737 → UHC-00389-04 (Betty Boyd)
Member id
UHC-00389-04
Confidence
1
Method
probabilistic
MBR-004129CLM-407737
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008175
Orphan claim re-pointed
Claims processor
CLM-405200 → UHC-39326-26 (Amy Reed)
Member id
UHC-39326-26
Confidence
1
Method
probabilistic
MBR-013035CLM-405200
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008176
Orphan claim re-pointed
Claims processor
CLM-426756 → UHC-51903-21 (Debra Andrews)
Member id
UHC-51903-21
Confidence
1
Method
probabilistic
MBR-034280CLM-426756
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008177
Orphan claim re-pointed
Claims processor
CLM-401347 → UHC-17441-60 (Rebecca Sims)
Member id
UHC-17441-60
Confidence
0.93
Method
probabilistic
MBR-006800CLM-401347
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008178
Orphan claim re-pointed
Claims processor
CLM-415407 → UHC-58083-73 (Jean Cruz)
Member id
UHC-58083-73
Confidence
1
Method
probabilistic
MBR-028817CLM-415407
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008179
Orphan claim re-pointed
Claims processor
CLM-432369 → UHC-01660-56 (Brandon Martin)
Member id
UHC-01660-56
Confidence
1
Method
probabilistic
MBR-012247CLM-432369
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008180
Orphan claim re-pointed
Claims processor
CLM-400497 → UHC-65932-60 (Judith Gonzales)
Member id
UHC-65932-60
Confidence
1
Method
probabilistic
MBR-011958CLM-400497
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008181
Orphan claim re-pointed
Claims processor
CLM-431881 → UHC-48820-35 (Gloria Lane)
Member id
UHC-48820-35
Confidence
0.97
Method
deterministic
MBR-008756CLM-431881
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008182
Orphan claim re-pointed
Claims processor
CLM-410840 → UHC-11699-14 (Amy Martin)
Member id
UHC-11699-14
Confidence
1
Method
probabilistic
MBR-018876CLM-410840
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008183
Orphan claim re-pointed
Claims processor
CLM-406443 → UHC-43328-08 (Abby Vazquez)
Member id
UHC-43328-08
Confidence
1
Method
probabilistic
MBR-011460CLM-406443
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008184
Orphan claim re-pointed
Claims processor
CLM-426050 → UHC-61080-99 (Sarah Carlson)
Member id
UHC-61080-99
Confidence
1
Method
probabilistic
MBR-025232CLM-426050
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008185
Orphan claim re-pointed
Claims processor
CLM-415758 → UHC-55567-38 (Michael Schultz)
Member id
UHC-55567-38
Confidence
0.97
Method
deterministic
MBR-000617CLM-415758
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008186
Orphan claim re-pointed
Claims processor
CLM-401987 → UHC-29928-29 (Stephen Garza)
Member id
UHC-29928-29
Confidence
1
Method
probabilistic
MBR-029823CLM-401987
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008187
Orphan claim re-pointed
Claims processor
CLM-420366 → UHC-82931-02 (Kayla Pena)
Member id
UHC-82931-02
Confidence
1
Method
probabilistic
MBR-020559CLM-420366
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008188
Orphan claim re-pointed
Claims processor
CLM-424174 → UHC-90955-10 (Doris Rice)
Member id
UHC-90955-10
Confidence
1
Method
probabilistic
MBR-036564CLM-424174
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008189
Orphan claim re-pointed
Claims processor
CLM-414138 → UHC-72994-01 (Raymond Banks)
Member id
UHC-72994-01
Confidence
1
Method
probabilistic
MBR-007745CLM-414138
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 137 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.