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-008540
Orphan claim re-pointed
Claims processor
CLM-411832 → UHC-39496-64 (Debra Cook)
Member id
UHC-39496-64
Confidence
1
Method
probabilistic
MBR-012737CLM-411832
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008541
Orphan claim re-pointed
Claims processor
CLM-430060 → UHC-16503-25 (Russell Gordon)
Member id
UHC-16503-25
Confidence
1
Method
probabilistic
MBR-002212CLM-430060
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008542
Orphan claim re-pointed
Claims processor
CLM-425301 → UHC-98479-41 (Theresa Rios)
Member id
UHC-98479-41
Confidence
1
Method
probabilistic
MBR-009000CLM-425301
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008543
Orphan claim re-pointed
Claims processor
CLM-419173 → UHC-24432-65 (Russell Cunningham)
Member id
UHC-24432-65
Confidence
0.97
Method
deterministic
MBR-024038CLM-419173
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008544
Orphan claim re-pointed
Claims processor
CLM-408918 → UHC-45527-99 (Wei Alexander)
Member id
UHC-45527-99
Confidence
0.97
Method
deterministic
MBR-023515CLM-408918
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008545
Orphan claim re-pointed
Claims processor
CLM-432654 → UHC-21594-17 (Stephen Watkins)
Member id
UHC-21594-17
Confidence
0.97
Method
deterministic
MBR-016003CLM-432654
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008546
Orphan claim re-pointed
Claims processor
CLM-404458 → UHC-48249-92 (Kelly Baker)
Member id
UHC-48249-92
Confidence
1
Method
probabilistic
MBR-000761CLM-404458
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008547
Orphan claim re-pointed
Claims processor
CLM-412835 → UHC-48987-35 (William Black)
Member id
UHC-48987-35
Confidence
1
Method
probabilistic
MBR-012887CLM-412835
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008548
Orphan claim re-pointed
Claims processor
CLM-417258 → UHC-61047-79 (Carolyn Gutierrez)
Member id
UHC-61047-79
Confidence
0.99
Method
probabilistic
MBR-040429CLM-417258
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008549
Orphan claim re-pointed
Claims processor
CLM-411975 → UHC-37749-59 (Anna Medina)
Member id
UHC-37749-59
Confidence
0.97
Method
deterministic
MBR-017072CLM-411975
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008550
Orphan claim re-pointed
Claims processor
CLM-409642 → UHC-10049-27 (Gerald Nichols)
Member id
UHC-10049-27
Confidence
1
Method
probabilistic
MBR-010210CLM-409642
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008551
Orphan claim re-pointed
Claims processor
CLM-415735 → UHC-78951-31 (Brian Wells)
Member id
UHC-78951-31
Confidence
1
Method
probabilistic
MBR-022470CLM-415735
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008552
Orphan claim re-pointed
Claims processor
CLM-412027 → UHC-77132-48 (Margaret Harris)
Member id
UHC-77132-48
Confidence
1
Method
probabilistic
MBR-025335CLM-412027
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008553
Orphan claim re-pointed
Claims processor
CLM-422162 → UHC-48834-19 (Amber Coleman)
Member id
UHC-48834-19
Confidence
1
Method
probabilistic
MBR-006900CLM-422162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008554
Orphan claim re-pointed
Claims processor
CLM-400642 → UHC-79256-52 (Yuki Berry)
Member id
UHC-79256-52
Confidence
0.85
Method
probabilistic
MBR-022534CLM-400642
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008555
Orphan claim re-pointed
Claims processor
CLM-415056 → UHC-89856-22 (Raymond Kim)
Member id
UHC-89856-22
Confidence
1
Method
probabilistic
MBR-010006CLM-415056
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008556
Orphan claim re-pointed
Claims processor
CLM-417421 → UHC-72089-26 (Juan Chen)
Member id
UHC-72089-26
Confidence
1
Method
probabilistic
MBR-000735CLM-417421
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008557
Orphan claim re-pointed
Claims processor
CLM-415533 → UHC-68186-75 (Jerry Dunn)
Member id
UHC-68186-75
Confidence
1
Method
probabilistic
MBR-017668CLM-415533
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008558
Orphan claim re-pointed
Claims processor
CLM-425336 → UHC-08701-85 (Larry Li)
Member id
UHC-08701-85
Confidence
0.97
Method
deterministic
MBR-014272CLM-425336
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008559
Orphan claim re-pointed
Claims processor
CLM-420916 → UHC-66768-58 (Janice Sandoval)
Member id
UHC-66768-58
Confidence
1
Method
probabilistic
MBR-014644CLM-420916
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008560
Orphan claim re-pointed
Claims processor
CLM-400003 → UHC-71667-70 (Christina Payne)
Member id
UHC-71667-70
Confidence
1
Method
probabilistic
MBR-029356CLM-400003
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008561
Orphan claim re-pointed
Claims processor
CLM-418972 → UHC-90592-70 (Logan Luna)
Member id
UHC-90592-70
Confidence
1
Method
probabilistic
MBR-002730CLM-418972
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008562
Orphan claim re-pointed
Claims processor
CLM-416260 → UHC-68676-39 (Heather Burton)
Member id
UHC-68676-39
Confidence
1
Method
probabilistic
MBR-010147CLM-416260
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008563
Orphan claim re-pointed
Claims processor
CLM-402317 → UHC-64640-18 (Laura Alvarado)
Member id
UHC-64640-18
Confidence
0.97
Method
deterministic
MBR-025866CLM-402317
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008564
Orphan claim re-pointed
Claims processor
CLM-409808 → UHC-50412-25 (Albert Williams)
Member id
UHC-50412-25
Confidence
1
Method
probabilistic
MBR-010881CLM-409808
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008565
Orphan claim re-pointed
Claims processor
CLM-429763 → UHC-97923-15 (Nicole Le)
Member id
UHC-97923-15
Confidence
1
Method
probabilistic
MBR-020070CLM-429763
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008566
Orphan claim re-pointed
Claims processor
CLM-420639 → UHC-14177-05 (Daniel McCoy)
Member id
UHC-14177-05
Confidence
0.97
Method
deterministic
MBR-019116CLM-420639
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008567
Orphan claim re-pointed
Claims processor
CLM-401047 → UHC-36281-66 (Christina Singh)
Member id
UHC-36281-66
Confidence
1
Method
probabilistic
MBR-011333CLM-401047
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008568
Orphan claim re-pointed
Claims processor
CLM-401198 → UHC-23992-53 (Daniel Hernandez)
Member id
UHC-23992-53
Confidence
1
Method
probabilistic
MBR-002334CLM-401198
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008569
Orphan claim re-pointed
Claims processor
CLM-425851 → UHC-07268-37 (Joshua Rios)
Member id
UHC-07268-37
Confidence
0.97
Method
deterministic
MBR-006041CLM-425851
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008570
Orphan claim re-pointed
Claims processor
CLM-402760 → UHC-45402-41 (James Ortiz)
Member id
UHC-45402-41
Confidence
1
Method
probabilistic
MBR-034607CLM-402760
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008571
Orphan claim re-pointed
Claims processor
CLM-421563 → UHC-53642-48 (Mason Banks)
Member id
UHC-53642-48
Confidence
1
Method
probabilistic
MBR-022560CLM-421563
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008572
Orphan claim re-pointed
Claims processor
CLM-417377 → UHC-54565-76 (Gerald Jordan)
Member id
UHC-54565-76
Confidence
1
Method
probabilistic
MBR-020402CLM-417377
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008573
Orphan claim re-pointed
Claims processor
CLM-432580 → UHC-77378-20 (Zachary Mitchell)
Member id
UHC-77378-20
Confidence
1
Method
probabilistic
MBR-004142CLM-432580
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008574
Orphan claim re-pointed
Claims processor
CLM-422108 → UHC-97248-72 (Megan Park)
Member id
UHC-97248-72
Confidence
0.97
Method
deterministic
MBR-005256CLM-422108
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008575
Orphan claim re-pointed
Claims processor
CLM-405141 → UHC-18138-25 (Steven Elliott)
Member id
UHC-18138-25
Confidence
1
Method
probabilistic
MBR-007344CLM-405141
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008576
Orphan claim re-pointed
Claims processor
CLM-412106 → UHC-96717-17 (Marilyn Li)
Member id
UHC-96717-17
Confidence
1
Method
probabilistic
MBR-029489CLM-412106
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008577
Orphan claim re-pointed
Claims processor
CLM-405558 → UHC-01436-76 (Maria Nguyen)
Member id
UHC-01436-76
Confidence
1
Method
probabilistic
MBR-006192CLM-405558
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008578
Orphan claim re-pointed
Claims processor
CLM-416246 → UHC-55928-14 (Nicholas Alexander)
Member id
UHC-55928-14
Confidence
1
Method
probabilistic
MBR-009107CLM-416246
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008579
Orphan claim re-pointed
Claims processor
CLM-411099 → UHC-75178-49 (Catherine Cunningham)
Member id
UHC-75178-49
Confidence
0.97
Method
deterministic
MBR-006771CLM-411099
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008580
Orphan claim re-pointed
Claims processor
CLM-428722 → UHC-95208-34 (Danielel Chapman)
Member id
UHC-95208-34
Confidence
1.00
Method
probabilistic
MBR-007005CLM-428722
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008581
Orphan claim re-pointed
Claims processor
CLM-406988 → UHC-95867-45 (Mark Hunt)
Member id
UHC-95867-45
Confidence
1
Method
probabilistic
MBR-005463CLM-406988
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008582
Orphan claim re-pointed
Claims processor
CLM-417414 → UHC-26771-60 (Angela Martin)
Member id
UHC-26771-60
Confidence
1
Method
probabilistic
MBR-010549CLM-417414
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008583
Orphan claim re-pointed
Claims processor
CLM-406386 → UHC-07884-13 (Ralph Gutierrez)
Member id
UHC-07884-13
Confidence
0.97
Method
deterministic
MBR-020176CLM-406386
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008584
Orphan claim re-pointed
Claims processor
CLM-423259 → UHC-59331-75 (Mark Howell)
Member id
UHC-59331-75
Confidence
1
Method
probabilistic
MBR-005541CLM-423259
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008585
Orphan claim re-pointed
Claims processor
CLM-407709 → UHC-80345-60 (Michelle Luna)
Member id
UHC-80345-60
Confidence
1
Method
probabilistic
MBR-034055CLM-407709
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008586
Orphan claim re-pointed
Claims processor
CLM-429412 → UHC-13009-12 (Raymond Day)
Member id
UHC-13009-12
Confidence
1
Method
probabilistic
MBR-021516CLM-429412
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008587
Orphan claim re-pointed
Claims processor
CLM-400142 → UHC-22408-95 (Judy Alvarez)
Member id
UHC-22408-95
Confidence
0.94
Method
probabilistic
MBR-004459CLM-400142
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008588
Orphan claim re-pointed
Claims processor
CLM-416157 → UHC-14111-62 (Megan Diaz)
Member id
UHC-14111-62
Confidence
0.97
Method
deterministic
MBR-024989CLM-416157
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008589
Orphan claim re-pointed
Claims processor
CLM-421273 → UHC-78003-20 (Janet Brown)
Member id
UHC-78003-20
Confidence
1
Method
probabilistic
MBR-011031CLM-421273
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 145 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.