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-009290
Orphan claim re-pointed
Claims processor
CLM-422230 → UHC-03433-45 (Samuel Perkins)
Member id
UHC-03433-45
Confidence
1
Method
probabilistic
MBR-009692CLM-422230
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009291
Orphan claim re-pointed
Claims processor
CLM-406729 → UHC-76046-66 (Jonathhan Owans)
Member id
UHC-76046-66
Confidence
0.98
Method
probabilistic
MBR-018328CLM-406729
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009292
Orphan claim re-pointed
Claims processor
CLM-415974 → UHC-40173-47 (Christina Bishop)
Member id
UHC-40173-47
Confidence
1.00
Method
probabilistic
MBR-003095CLM-415974
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009293
Orphan claim re-pointed
Claims processor
CLM-407299 → UHC-53118-31 (Daniel Freeman)
Member id
UHC-53118-31
Confidence
1
Method
probabilistic
MBR-032585CLM-407299
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009294
Orphan claim re-pointed
Claims processor
CLM-416118 → UHC-43006-53 (Frances Reed)
Member id
UHC-43006-53
Confidence
1
Method
probabilistic
MBR-029315CLM-416118
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009295
Orphan claim re-pointed
Claims processor
CLM-400236 → UHC-96990-15 (Angela Espinoza)
Member id
UHC-96990-15
Confidence
0.99
Method
probabilistic
MBR-017663CLM-400236
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009296
Orphan claim re-pointed
Claims processor
CLM-422154 → UHC-04832-19 (Douglas Jensen)
Member id
UHC-04832-19
Confidence
1
Method
probabilistic
MBR-022792CLM-422154
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009297
Orphan claim re-pointed
Claims processor
CLM-416864 → UHC-27727-94 (Angela Garrett)
Member id
UHC-27727-94
Confidence
0.99
Method
probabilistic
MBR-017557CLM-416864
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009298
Orphan claim re-pointed
Claims processor
CLM-419342 → UHC-94105-73 (Richard Boyd)
Member id
UHC-94105-73
Confidence
1
Method
probabilistic
MBR-004511CLM-419342
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009299
Orphan claim re-pointed
Claims processor
CLM-423110 → UHC-12266-19 (Emily Little)
Member id
UHC-12266-19
Confidence
1
Method
probabilistic
MBR-000592CLM-423110
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009300
Orphan claim re-pointed
Claims processor
CLM-413367 → UHC-50684-24 (Rachel Marshall)
Member id
UHC-50684-24
Confidence
1
Method
probabilistic
MBR-002189CLM-413367
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009301
Orphan claim re-pointed
Claims processor
CLM-417797 → UHC-93719-60 (Justin Gordon)
Member id
UHC-93719-60
Confidence
1
Method
probabilistic
MBR-008016CLM-417797
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009302
Orphan claim re-pointed
Claims processor
CLM-409603 → UHC-88185-60 (Ryan Evans)
Member id
UHC-88185-60
Confidence
1
Method
probabilistic
MBR-012300CLM-409603
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009303
Orphan claim re-pointed
Claims processor
CLM-406867 → UHC-61614-40 (Virginia Carr)
Member id
UHC-61614-40
Confidence
1
Method
probabilistic
MBR-012558CLM-406867
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009304
Orphan claim re-pointed
Claims processor
CLM-432583 → UHC-62488-93 (Mateo Carlson)
Member id
UHC-62488-93
Confidence
0.90
Method
probabilistic
MBR-045486CLM-432583
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009305
Orphan claim re-pointed
Claims processor
CLM-414468 → UHC-46233-87 (William Allen)
Member id
UHC-46233-87
Confidence
1
Method
probabilistic
MBR-002181CLM-414468
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009306
Orphan claim re-pointed
Claims processor
CLM-402413 → UHC-40801-57 (Eugene Duncan)
Member id
UHC-40801-57
Confidence
1
Method
probabilistic
MBR-015256CLM-402413
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009307
Orphan claim re-pointed
Claims processor
CLM-408281 → UHC-78528-57 (Betty Williamson)
Member id
UHC-78528-57
Confidence
1
Method
probabilistic
MBR-014606CLM-408281
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009308
Orphan claim re-pointed
Claims processor
CLM-422982 → UHC-58276-63 (Omar Schultz)
Member id
UHC-58276-63
Confidence
0.97
Method
deterministic
MBR-014878CLM-422982
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009309
Orphan claim re-pointed
Claims processor
CLM-417844 → UHC-68577-83 (Walter Dominguez)
Member id
UHC-68577-83
Confidence
1
Method
probabilistic
MBR-025863CLM-417844
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009310
Orphan claim re-pointed
Claims processor
CLM-413947 → UHC-34110-11 (Mason Rios)
Member id
UHC-34110-11
Confidence
0.94
Method
probabilistic
MBR-020572CLM-413947
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009311
Orphan claim re-pointed
Claims processor
CLM-432523 → UHC-05149-71 (Brandon Graham)
Member id
UHC-05149-71
Confidence
1
Method
probabilistic
MBR-019696CLM-432523
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009312
Orphan claim re-pointed
Claims processor
CLM-423294 → UHC-86873-43 (Adam Wood)
Member id
UHC-86873-43
Confidence
1
Method
probabilistic
MBR-032952CLM-423294
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009313
Orphan claim re-pointed
Claims processor
CLM-425202 → UHC-01286-91 (Vincent Lee)
Member id
UHC-01286-91
Confidence
0.97
Method
deterministic
MBR-000279CLM-425202
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009314
Orphan claim re-pointed
Claims processor
CLM-401815 → UHC-19141-31 (Theresa Fowler)
Member id
UHC-19141-31
Confidence
1
Method
probabilistic
MBR-004374CLM-401815
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009315
Orphan claim re-pointed
Claims processor
CLM-426988 → UHC-99713-52 (Walter Sandoval)
Member id
UHC-99713-52
Confidence
1
Method
probabilistic
MBR-005283CLM-426988
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009316
Orphan claim re-pointed
Claims processor
CLM-430901 → UHC-76444-88 (Virginia Harvey)
Member id
UHC-76444-88
Confidence
0.97
Method
deterministic
MBR-002296CLM-430901
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009317
Orphan claim re-pointed
Claims processor
CLM-410250 → UHC-83567-23 (David Wheeler)
Member id
UHC-83567-23
Confidence
0.97
Method
deterministic
MBR-019411CLM-410250
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009318
Orphan claim re-pointed
Claims processor
CLM-412214 → UHC-14032-93 (Dennis Perez)
Member id
UHC-14032-93
Confidence
1
Method
probabilistic
MBR-022525CLM-412214
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009319
Orphan claim re-pointed
Claims processor
CLM-425234 → UHC-84849-71 (David Nguyen)
Member id
UHC-84849-71
Confidence
1
Method
probabilistic
MBR-011436CLM-425234
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009320
Orphan claim re-pointed
Claims processor
CLM-415393 → UHC-35933-47 (Kathryn Stephens)
Member id
UHC-35933-47
Confidence
1
Method
probabilistic
MBR-028060CLM-415393
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009321
Orphan claim re-pointed
Claims processor
CLM-414293 → UHC-05912-11 (Camila Ortiz)
Member id
UHC-05912-11
Confidence
1
Method
probabilistic
MBR-038267CLM-414293
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009322
Orphan claim re-pointed
Claims processor
CLM-420385 → UHC-24738-29 (Beverly Payne)
Member id
UHC-24738-29
Confidence
1
Method
probabilistic
MBR-030207CLM-420385
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009323
Orphan claim re-pointed
Claims processor
CLM-422462 → UHC-23637-74 (Scott Thomas)
Member id
UHC-23637-74
Confidence
1
Method
probabilistic
MBR-019374CLM-422462
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009324
Orphan claim re-pointed
Claims processor
CLM-400805 → UHC-37944-44 (Steven Armstrong)
Member id
UHC-37944-44
Confidence
0.97
Method
deterministic
MBR-021100CLM-400805
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009325
Orphan claim re-pointed
Claims processor
CLM-421845 → UHC-39649-87 (Zachaary Schmidt)
Member id
UHC-39649-87
Confidence
0.97
Method
deterministic
MBR-015155CLM-421845
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009326
Orphan claim re-pointed
Claims processor
CLM-425919 → UHC-10286-63 (Stephanie Martinez)
Member id
UHC-10286-63
Confidence
0.93
Method
probabilistic
MBR-009899CLM-425919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009327
Orphan claim re-pointed
Claims processor
CLM-429416 → UHC-76690-56 (Douglas Lewis)
Member id
UHC-76690-56
Confidence
1
Method
probabilistic
MBR-022670CLM-429416
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009328
Orphan claim re-pointed
Claims processor
CLM-431793 → UHC-26515-31 (Anthony Ortiz)
Member id
UHC-26515-31
Confidence
1
Method
probabilistic
MBR-030401CLM-431793
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009329
Orphan claim re-pointed
Claims processor
CLM-427890 → UHC-80821-83 (Emily Palmer)
Member id
UHC-80821-83
Confidence
0.99
Method
probabilistic
MBR-005149CLM-427890
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009330
Orphan claim re-pointed
Claims processor
CLM-420636 → UHC-89527-97 (Jackie Munoz)
Member id
UHC-89527-97
Confidence
1
Method
probabilistic
MBR-019058CLM-420636
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009331
Orphan claim re-pointed
Claims processor
CLM-411072 → UHC-35219-28 (Elizabeth Tucker)
Member id
UHC-35219-28
Confidence
0.97
Method
deterministic
MBR-029921CLM-411072
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009332
Orphan claim re-pointed
Claims processor
CLM-427998 → UHC-71867-23 (Shirley Carr)
Member id
UHC-71867-23
Confidence
1
Method
probabilistic
MBR-017170CLM-427998
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009333
Orphan claim re-pointed
Claims processor
CLM-422831 → UHC-24778-33 (Timothy Carpenter)
Member id
UHC-24778-33
Confidence
0.99
Method
probabilistic
MBR-001065CLM-422831
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009334
Orphan claim re-pointed
Claims processor
CLM-428463 → UHC-81512-01 (Betty Weber)
Member id
UHC-81512-01
Confidence
1
Method
probabilistic
MBR-037330CLM-428463
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009335
Orphan claim re-pointed
Claims processor
CLM-407455 → UHC-82007-66 (Jose Reyes)
Member id
UHC-82007-66
Confidence
1
Method
probabilistic
MBR-036095CLM-407455
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009336
Orphan claim re-pointed
Claims processor
CLM-420584 → UHC-14069-21 (Gregory Hudson)
Member id
UHC-14069-21
Confidence
0.97
Method
deterministic
MBR-005963CLM-420584
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009337
Orphan claim re-pointed
Claims processor
CLM-408211 → UHC-31536-42 (Michael Wallace)
Member id
UHC-31536-42
Confidence
1
Method
probabilistic
MBR-013693CLM-408211
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009338
Orphan claim re-pointed
Claims processor
CLM-410941 → UHC-46404-59 (Sarah Fernandez)
Member id
UHC-46404-59
Confidence
0.91
Method
probabilistic
MBR-032504CLM-410941
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009339
Orphan claim re-pointed
Claims processor
CLM-430182 → UHC-30928-47 (Keith Howell)
Member id
UHC-30928-47
Confidence
1
Method
probabilistic
MBR-006729CLM-430182
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 160 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.