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-009140
Orphan claim re-pointed
Claims processor
CLM-402501 → UHC-81063-83 (Lauren Nunez)
Member id
UHC-81063-83
Confidence
1
Method
probabilistic
MBR-002587CLM-402501
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009141
Orphan claim re-pointed
Claims processor
CLM-401180 → UHC-89423-86 (Diego Bishop)
Member id
UHC-89423-86
Confidence
1
Method
probabilistic
MBR-022430CLM-401180
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009142
Orphan claim re-pointed
Claims processor
CLM-425712 → UHC-99938-63 (Ronald Morales)
Member id
UHC-99938-63
Confidence
0.97
Method
deterministic
MBR-001108CLM-425712
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009143
Orphan claim re-pointed
Claims processor
CLM-419572 → UHC-36595-86 (Eugene Perez)
Member id
UHC-36595-86
Confidence
1
Method
probabilistic
MBR-025903CLM-419572
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009144
Orphan claim re-pointed
Claims processor
CLM-404179 → UHC-51717-16 (Willie Price)
Member id
UHC-51717-16
Confidence
1
Method
probabilistic
MBR-014007CLM-404179
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009145
Orphan claim re-pointed
Claims processor
CLM-417584 → UHC-05122-10 (Mateo Willis)
Member id
UHC-05122-10
Confidence
0.97
Method
deterministic
MBR-004752CLM-417584
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009146
Orphan claim re-pointed
Claims processor
CLM-423056 → UHC-74392-69 (Ben Barnes)
Member id
UHC-74392-69
Confidence
0.92
Method
probabilistic
MBR-026241CLM-423056
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009147
Orphan claim re-pointed
Claims processor
CLM-410460 → UHC-03711-37 (Zachary Green)
Member id
UHC-03711-37
Confidence
1
Method
probabilistic
MBR-004833CLM-410460
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009148
Orphan claim re-pointed
Claims processor
CLM-429274 → UHC-64162-90 (Joyce Howard)
Member id
UHC-64162-90
Confidence
0.98
Method
probabilistic
MBR-009320CLM-429274
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009149
Orphan claim re-pointed
Claims processor
CLM-421505 → UHC-98726-28 (Donald Wite)
Member id
UHC-98726-28
Confidence
0.99
Method
probabilistic
MBR-010255CLM-421505
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009150
Orphan claim re-pointed
Claims processor
CLM-426310 → UHC-51764-25 (Olivia Bailey)
Member id
UHC-51764-25
Confidence
0.97
Method
deterministic
MBR-010013CLM-426310
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009151
Orphan claim re-pointed
Claims processor
CLM-425826 → UHC-25328-51 (Ahmed Barnes)
Member id
UHC-25328-51
Confidence
1
Method
probabilistic
MBR-029675CLM-425826
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009152
Orphan claim re-pointed
Claims processor
CLM-428079 → UHC-03389-40 (Cheryl Martinez)
Member id
UHC-03389-40
Confidence
1
Method
probabilistic
MBR-024025CLM-428079
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009153
Orphan claim re-pointed
Claims processor
CLM-414867 → UHC-70103-18 (Jeremy Williamson)
Member id
UHC-70103-18
Confidence
1
Method
probabilistic
MBR-006283CLM-414867
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009154
Orphan claim re-pointed
Claims processor
CLM-411543 → UHC-51126-87 (Jack Carter)
Member id
UHC-51126-87
Confidence
0.93
Method
probabilistic
MBR-006525CLM-411543
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009155
Orphan claim re-pointed
Claims processor
CLM-406414 → UHC-00910-34 (Anthony Barnes)
Member id
UHC-00910-34
Confidence
1
Method
probabilistic
MBR-024356CLM-406414
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009156
Orphan claim re-pointed
Claims processor
CLM-427004 → UHC-89336-04 (Nathan Gutierrez)
Member id
UHC-89336-04
Confidence
0.97
Method
deterministic
MBR-037495CLM-427004
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009157
Orphan claim re-pointed
Claims processor
CLM-400620 → UHC-65560-71 (Gary Gutierrez)
Member id
UHC-65560-71
Confidence
0.93
Method
probabilistic
MBR-002163CLM-400620
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009158
Orphan claim re-pointed
Claims processor
CLM-403919 → UHC-05862-91 (Zachary Carlson)
Member id
UHC-05862-91
Confidence
1
Method
probabilistic
MBR-008576CLM-403919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009159
Orphan claim re-pointed
Claims processor
CLM-431896 → UHC-00300-86 (Melissa Medina)
Member id
UHC-00300-86
Confidence
1
Method
probabilistic
MBR-004470CLM-431896
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009160
Orphan claim re-pointed
Claims processor
CLM-410121 → UHC-07328-18 (Dylan Oliver)
Member id
UHC-07328-18
Confidence
0.97
Method
deterministic
MBR-027262CLM-410121
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009161
Orphan claim re-pointed
Claims processor
CLM-419368 → UHC-56320-70 (Sean Nunez)
Member id
UHC-56320-70
Confidence
1
Method
probabilistic
MBR-028426CLM-419368
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009162
Orphan claim re-pointed
Claims processor
CLM-421653 → UHC-48927-65 (James Maldonado)
Member id
UHC-48927-65
Confidence
1
Method
probabilistic
MBR-027302CLM-421653
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009163
Orphan claim re-pointed
Claims processor
CLM-409302 → UHC-53249-64 (Nataliie Wells)
Member id
UHC-53249-64
Confidence
0.97
Method
deterministic
MBR-002958CLM-409302
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009164
Orphan claim re-pointed
Claims processor
CLM-430874 → UHC-99631-53 (Stephen Padilla)
Member id
UHC-99631-53
Confidence
1
Method
probabilistic
MBR-032454CLM-430874
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009165
Orphan claim re-pointed
Claims processor
CLM-419521 → UHC-85777-05 (Peter Castillo)
Member id
UHC-85777-05
Confidence
1
Method
probabilistic
MBR-000993CLM-419521
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009166
Orphan claim re-pointed
Claims processor
CLM-424577 → UHC-88200-35 (Kelly Shaw)
Member id
UHC-88200-35
Confidence
1
Method
probabilistic
MBR-000367CLM-424577
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009167
Orphan claim re-pointed
Claims processor
CLM-420406 → UHC-26372-60 (Sara Harvey)
Member id
UHC-26372-60
Confidence
1
Method
probabilistic
MBR-013861CLM-420406
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009168
Orphan claim re-pointed
Claims processor
CLM-407921 → UHC-31162-50 (Randy Murphy)
Member id
UHC-31162-50
Confidence
1
Method
probabilistic
MBR-020827CLM-407921
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009169
Orphan claim re-pointed
Claims processor
CLM-413440 → UHC-63823-65 (Bruce Garza)
Member id
UHC-63823-65
Confidence
1
Method
probabilistic
MBR-015951CLM-413440
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009170
Orphan claim re-pointed
Claims processor
CLM-406508 → UHC-92335-51 (Jordan Garcia)
Member id
UHC-92335-51
Confidence
1
Method
probabilistic
MBR-010350CLM-406508
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009171
Orphan claim re-pointed
Claims processor
CLM-410569 → UHC-43471-66 (Marilyn Patterson)
Member id
UHC-43471-66
Confidence
1
Method
probabilistic
MBR-002446CLM-410569
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009172
Orphan claim re-pointed
Claims processor
CLM-419654 → UHC-03351-44 (Lisa Vargas)
Member id
UHC-03351-44
Confidence
0.97
Method
deterministic
MBR-021738CLM-419654
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009173
Orphan claim re-pointed
Claims processor
CLM-406422 → UHC-16872-58 (Stephanie Burns)
Member id
UHC-16872-58
Confidence
1
Method
probabilistic
MBR-016389CLM-406422
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009174
Orphan claim re-pointed
Claims processor
CLM-405116 → UHC-51047-78 (Jesse Carroll)
Member id
UHC-51047-78
Confidence
0.97
Method
deterministic
MBR-024180CLM-405116
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009175
Orphan claim re-pointed
Claims processor
CLM-405707 → UHC-61535-22 (Arjun Wallace)
Member id
UHC-61535-22
Confidence
1
Method
probabilistic
MBR-001201CLM-405707
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009176
Orphan claim re-pointed
Claims processor
CLM-409067 → UHC-60107-66 (Stephen Scott)
Member id
UHC-60107-66
Confidence
1
Method
probabilistic
MBR-005964CLM-409067
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009177
Orphan claim re-pointed
Claims processor
CLM-420964 → UHC-35949-93 (Arthur Kelley)
Member id
UHC-35949-93
Confidence
1
Method
probabilistic
MBR-024768CLM-420964
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009178
Orphan claim re-pointed
Claims processor
CLM-428905 → UHC-05355-82 (Joyce Mendoza)
Member id
UHC-05355-82
Confidence
0.97
Method
deterministic
MBR-016491CLM-428905
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009179
Orphan claim re-pointed
Claims processor
CLM-401360 → UHC-95131-79 (Barbara Taylor)
Member id
UHC-95131-79
Confidence
1
Method
probabilistic
MBR-024738CLM-401360
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009180
Orphan claim re-pointed
Claims processor
CLM-406775 → UHC-24250-02 (Carl Owens)
Member id
UHC-24250-02
Confidence
1
Method
probabilistic
MBR-006677CLM-406775
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009181
Orphan claim re-pointed
Claims processor
CLM-408204 → UHC-17925-71 (Sarah Barnes)
Member id
UHC-17925-71
Confidence
0.97
Method
deterministic
MBR-037496CLM-408204
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009182
Orphan claim re-pointed
Claims processor
CLM-418351 → UHC-74847-84 (Bobby Wright)
Member id
UHC-74847-84
Confidence
1
Method
probabilistic
MBR-005523CLM-418351
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009183
Orphan claim re-pointed
Claims processor
CLM-402965 → UHC-44414-07 (Julie Boyd)
Member id
UHC-44414-07
Confidence
0.97
Method
deterministic
MBR-019470CLM-402965
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009184
Orphan claim re-pointed
Claims processor
CLM-431158 → UHC-90196-95 (Ethan Thompson)
Member id
UHC-90196-95
Confidence
0.97
Method
deterministic
MBR-035164CLM-431158
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009185
Orphan claim re-pointed
Claims processor
CLM-426309 → UHC-51764-25 (Olivia Bailey)
Member id
UHC-51764-25
Confidence
0.94
Method
probabilistic
MBR-010013CLM-426309
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009186
Orphan claim re-pointed
Claims processor
CLM-400892 → UHC-11140-30 (Amber Johnston)
Member id
UHC-11140-30
Confidence
0.97
Method
deterministic
MBR-019687CLM-400892
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009187
Orphan claim re-pointed
Claims processor
CLM-415568 → UHC-04897-53 (Benjamin Singh)
Member id
UHC-04897-53
Confidence
0.97
Method
deterministic
MBR-003980CLM-415568
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009188
Orphan claim re-pointed
Claims processor
CLM-408893 → UHC-65157-91 (Jean Carr)
Member id
UHC-65157-91
Confidence
1
Method
probabilistic
MBR-004956CLM-408893
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009189
Orphan claim re-pointed
Claims processor
CLM-425739 → UHC-85052-29 (Luis Dominguez)
Member id
UHC-85052-29
Confidence
1
Method
probabilistic
MBR-016468CLM-425739
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 157 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.