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-009540
Orphan claim re-pointed
Claims processor
CLM-426058 → UHC-29564-55 (Carol Arnold)
Member id
UHC-29564-55
Confidence
1
Method
probabilistic
MBR-006224CLM-426058
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009541
Orphan claim re-pointed
Claims processor
CLM-411152 → UHC-10284-69 (Megan Burke)
Member id
UHC-10284-69
Confidence
0.97
Method
deterministic
MBR-033441CLM-411152
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009542
Orphan claim re-pointed
Claims processor
CLM-428800 → UHC-17958-15 (Hiroshi Shaw)
Member id
UHC-17958-15
Confidence
0.97
Method
deterministic
MBR-015681CLM-428800
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009543
Orphan claim re-pointed
Claims processor
CLM-423978 → UHC-23564-09 (Kimberly Dominguez)
Member id
UHC-23564-09
Confidence
1
Method
probabilistic
MBR-004737CLM-423978
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009544
Orphan claim re-pointed
Claims processor
CLM-428327 → UHC-92262-47 (Valentina Greene)
Member id
UHC-92262-47
Confidence
1
Method
probabilistic
MBR-037961CLM-428327
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009545
Orphan claim re-pointed
Claims processor
CLM-420156 → UHC-63388-86 (Theresa Tucker)
Member id
UHC-63388-86
Confidence
0.94
Method
probabilistic
MBR-019489CLM-420156
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009546
Orphan claim re-pointed
Claims processor
CLM-419530 → UHC-16662-97 (Ashley Munoz)
Member id
UHC-16662-97
Confidence
1
Method
probabilistic
MBR-006139CLM-419530
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009547
Orphan claim re-pointed
Claims processor
CLM-403332 → UHC-81477-97 (Teresa Hayes)
Member id
UHC-81477-97
Confidence
1
Method
probabilistic
MBR-012681CLM-403332
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009548
Orphan claim re-pointed
Claims processor
CLM-411655 → UHC-19399-24 (Ann Williamson)
Member id
UHC-19399-24
Confidence
1
Method
probabilistic
MBR-005080CLM-411655
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009549
Orphan claim re-pointed
Claims processor
CLM-409473 → UHC-58278-39 (Douglas Robinson)
Member id
UHC-58278-39
Confidence
1
Method
probabilistic
MBR-020061CLM-409473
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009550
Orphan claim re-pointed
Claims processor
CLM-410056 → UHC-99251-17 (Randy Mason)
Member id
UHC-99251-17
Confidence
0.97
Method
deterministic
MBR-030737CLM-410056
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009551
Orphan claim re-pointed
Claims processor
CLM-404594 → UHC-13136-66 (Amber Mejia)
Member id
UHC-13136-66
Confidence
1
Method
probabilistic
MBR-017053CLM-404594
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009552
Orphan claim re-pointed
Claims processor
CLM-423159 → UHC-31409-02 (Ryan Soto)
Member id
UHC-31409-02
Confidence
1
Method
probabilistic
MBR-025104CLM-423159
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009553
Orphan claim re-pointed
Claims processor
CLM-414540 → UHC-56827-60 (Bobby Carroll)
Member id
UHC-56827-60
Confidence
0.97
Method
deterministic
MBR-024104CLM-414540
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009554
Orphan claim re-pointed
Claims processor
CLM-408276 → UHC-42995-06 (Debra Fuller)
Member id
UHC-42995-06
Confidence
1
Method
probabilistic
MBR-025528CLM-408276
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009555
Orphan claim re-pointed
Claims processor
CLM-423794 → UHC-39955-17 (Samantha Reid)
Member id
UHC-39955-17
Confidence
1
Method
probabilistic
MBR-005939CLM-423794
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009556
Orphan claim re-pointed
Claims processor
CLM-425927 → UHC-21896-71 (Benjamin Brown)
Member id
UHC-21896-71
Confidence
0.97
Method
deterministic
MBR-013190CLM-425927
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009557
Orphan claim re-pointed
Claims processor
CLM-418598 → UHC-26249-22 (Henry Daniels)
Member id
UHC-26249-22
Confidence
0.99
Method
probabilistic
MBR-016105CLM-418598
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009558
Orphan claim re-pointed
Claims processor
CLM-417709 → UHC-65636-63 (Noah James)
Member id
UHC-65636-63
Confidence
1
Method
probabilistic
MBR-030355CLM-417709
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009559
Orphan claim re-pointed
Claims processor
CLM-400162 → UHC-59351-27 (Cynthia Peterson)
Member id
UHC-59351-27
Confidence
1
Method
probabilistic
MBR-032047CLM-400162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009560
Orphan claim re-pointed
Claims processor
CLM-416666 → UHC-82604-10 (Andrea Lawson)
Member id
UHC-82604-10
Confidence
1
Method
probabilistic
MBR-007026CLM-416666
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009561
Orphan claim re-pointed
Claims processor
CLM-412565 → UHC-31114-80 (Kathleen Lane)
Member id
UHC-31114-80
Confidence
1
Method
probabilistic
MBR-008165CLM-412565
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009562
Orphan claim re-pointed
Claims processor
CLM-415696 → UHC-13174-98 (Judy Burns)
Member id
UHC-13174-98
Confidence
1
Method
probabilistic
MBR-007661CLM-415696
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009563
Orphan claim re-pointed
Claims processor
CLM-430298 → UHC-61149-15 (Alexander Snyder)
Member id
UHC-61149-15
Confidence
1
Method
probabilistic
MBR-007090CLM-430298
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009564
Orphan claim re-pointed
Claims processor
CLM-429430 → UHC-40897-12 (Dorothy Collins)
Member id
UHC-40897-12
Confidence
1
Method
probabilistic
MBR-025529CLM-429430
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009565
Orphan claim re-pointed
Claims processor
CLM-409083 → UHC-61419-84 (Kathryn Knight)
Member id
UHC-61419-84
Confidence
1
Method
probabilistic
MBR-013145CLM-409083
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009566
Orphan claim re-pointed
Claims processor
CLM-407940 → UHC-60762-21 (Donald Castro)
Member id
UHC-60762-21
Confidence
1
Method
probabilistic
MBR-021067CLM-407940
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009567
Orphan claim re-pointed
Claims processor
CLM-408812 → UHC-12996-17 (Mary Burton)
Member id
UHC-12996-17
Confidence
0.97
Method
deterministic
MBR-034232CLM-408812
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009568
Orphan claim re-pointed
Claims processor
CLM-422379 → UHC-45736-97 (David Hicks)
Member id
UHC-45736-97
Confidence
1
Method
probabilistic
MBR-010523CLM-422379
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009569
Orphan claim re-pointed
Claims processor
CLM-402232 → UHC-11287-52 (Stephanie Harvey)
Member id
UHC-11287-52
Confidence
0.87
Method
probabilistic
MBR-033790CLM-402232
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009570
Orphan claim re-pointed
Claims processor
CLM-426634 → UHC-62320-38 (Barbara Cooper)
Member id
UHC-62320-38
Confidence
1
Method
probabilistic
MBR-012284CLM-426634
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009571
Orphan claim re-pointed
Claims processor
CLM-431165 → UHC-21829-60 (Rachel Walker)
Member id
UHC-21829-60
Confidence
0.93
Method
probabilistic
MBR-026510CLM-431165
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009572
Orphan claim re-pointed
Claims processor
CLM-423935 → UHC-37895-83 (Kenneth Johnston)
Member id
UHC-37895-83
Confidence
1
Method
probabilistic
MBR-015283CLM-423935
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009573
Orphan claim re-pointed
Claims processor
CLM-409683 → UHC-58749-30 (Alice Foster)
Member id
UHC-58749-30
Confidence
0.99
Method
probabilistic
MBR-017030CLM-409683
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009574
Orphan claim re-pointed
Claims processor
CLM-406514 → UHC-58654-72 (Virginia Berry)
Member id
UHC-58654-72
Confidence
1
Method
probabilistic
MBR-015241CLM-406514
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009575
Orphan claim re-pointed
Claims processor
CLM-414254 → UHC-23742-38 (Brittany Romero)
Member id
UHC-23742-38
Confidence
1
Method
probabilistic
MBR-027504CLM-414254
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009576
Orphan claim re-pointed
Claims processor
CLM-414509 → UHC-70261-24 (Samuel Guerrero)
Member id
UHC-70261-24
Confidence
1
Method
probabilistic
MBR-001242CLM-414509
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009577
Orphan claim re-pointed
Claims processor
CLM-420557 → UHC-21260-01 (Natalie Moore)
Member id
UHC-21260-01
Confidence
1
Method
probabilistic
MBR-028343CLM-420557
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009578
Orphan claim re-pointed
Claims processor
CLM-402348 → UHC-68685-92 (Mary Allen)
Member id
UHC-68685-92
Confidence
0.97
Method
probabilistic
MBR-002549CLM-402348
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009579
Orphan claim re-pointed
Claims processor
CLM-431419 → UHC-90045-65 (Joan Elliott)
Member id
UHC-90045-65
Confidence
1
Method
probabilistic
MBR-016189CLM-431419
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009580
Orphan claim re-pointed
Claims processor
CLM-418988 → UHC-44369-43 (Sophia Rogers)
Member id
UHC-44369-43
Confidence
0.97
Method
deterministic
MBR-028751CLM-418988
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009581
Orphan claim re-pointed
Claims processor
CLM-412064 → UHC-55338-16 (Kathryn Salazar)
Member id
UHC-55338-16
Confidence
0.97
Method
deterministic
MBR-022992CLM-412064
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009582
Orphan claim re-pointed
Claims processor
CLM-405026 → UHC-16902-14 (Christine Kelly)
Member id
UHC-16902-14
Confidence
0.94
Method
probabilistic
MBR-019123CLM-405026
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009583
Orphan claim re-pointed
Claims processor
CLM-411262 → UHC-28602-56 (Adam Bailey)
Member id
UHC-28602-56
Confidence
1
Method
probabilistic
MBR-007492CLM-411262
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009584
Orphan claim re-pointed
Claims processor
CLM-425274 → UHC-27517-35 (Randy Ortiz)
Member id
UHC-27517-35
Confidence
1
Method
probabilistic
MBR-005299CLM-425274
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009585
Orphan claim re-pointed
Claims processor
CLM-419031 → UHC-09498-69 (Stephanie Long)
Member id
UHC-09498-69
Confidence
0.99
Method
probabilistic
MBR-030711CLM-419031
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009586
Orphan claim re-pointed
Claims processor
CLM-422483 → UHC-65025-01 (Bobby Wilson)
Member id
UHC-65025-01
Confidence
1
Method
probabilistic
MBR-004716CLM-422483
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009587
Orphan claim re-pointed
Claims processor
CLM-418441 → UHC-18764-68 (Harrold Morrison)
Member id
UHC-18764-68
Confidence
0.99
Method
probabilistic
MBR-021674CLM-418441
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009588
Orphan claim re-pointed
Claims processor
CLM-402766 → UHC-54330-79 (Lori Santos)
Member id
UHC-54330-79
Confidence
1
Method
probabilistic
MBR-002566CLM-402766
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009589
Orphan claim re-pointed
Claims processor
CLM-420100 → UHC-20965-16 (Dorothy Greene)
Member id
UHC-20965-16
Confidence
1
Method
probabilistic
MBR-000287CLM-420100
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 165 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.