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-009690
Orphan claim re-pointed
Claims processor
CLM-431775 → UHC-04842-26 (Dorothy Freeman)
Member id
UHC-04842-26
Confidence
1
Method
probabilistic
MBR-042801CLM-431775
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009691
Orphan claim re-pointed
Claims processor
CLM-424691 → UHC-21980-71 (Julia Dean)
Member id
UHC-21980-71
Confidence
1
Method
probabilistic
MBR-023940CLM-424691
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009692
Orphan claim re-pointed
Claims processor
CLM-424998 → UHC-02366-75 (Thomas Sanchez)
Member id
UHC-02366-75
Confidence
0.99
Method
probabilistic
MBR-006735CLM-424998
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009693
Orphan claim re-pointed
Claims processor
CLM-427817 → UHC-77908-77 (Camila Gibson)
Member id
UHC-77908-77
Confidence
1
Method
probabilistic
MBR-028550CLM-427817
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009694
Orphan claim re-pointed
Claims processor
CLM-414464 → UHC-13987-43 (Lucia Russell)
Member id
UHC-13987-43
Confidence
1
Method
probabilistic
MBR-016085CLM-414464
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009695
Orphan claim re-pointed
Claims processor
CLM-422402 → UHC-06772-04 (Sharon Campbell)
Member id
UHC-06772-04
Confidence
1
Method
probabilistic
MBR-015467CLM-422402
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009696
Orphan claim re-pointed
Claims processor
CLM-425624 → UHC-56620-79 (Mason McDunald)
Member id
UHC-56620-79
Confidence
0.97
Method
deterministic
MBR-017492CLM-425624
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009697
Orphan claim re-pointed
Claims processor
CLM-405318 → UHC-84944-11 (Danielle Jackson)
Member id
UHC-84944-11
Confidence
0.97
Method
deterministic
MBR-023629CLM-405318
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009698
Orphan claim re-pointed
Claims processor
CLM-404851 → UHC-96694-14 (Russell Elliott)
Member id
UHC-96694-14
Confidence
1
Method
probabilistic
MBR-002787CLM-404851
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009699
Orphan claim re-pointed
Claims processor
CLM-400772 → UHC-08091-97 (Angela Yang)
Member id
UHC-08091-97
Confidence
1
Method
probabilistic
MBR-001459CLM-400772
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009700
Orphan claim re-pointed
Claims processor
CLM-414731 → UHC-18573-78 (Albert Marquez)
Member id
UHC-18573-78
Confidence
1
Method
probabilistic
MBR-021350CLM-414731
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009701
Orphan claim re-pointed
Claims processor
CLM-418089 → UHC-72352-98 (Brian McCoy)
Member id
UHC-72352-98
Confidence
1
Method
probabilistic
MBR-015796CLM-418089
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009702
Orphan claim re-pointed
Claims processor
CLM-409746 → UHC-75122-99 (Bruce Rios)
Member id
UHC-75122-99
Confidence
0.94
Method
probabilistic
MBR-019512CLM-409746
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009703
Orphan claim re-pointed
Claims processor
CLM-432498 → UHC-45875-06 (Kelly Gonzalez)
Member id
UHC-45875-06
Confidence
1
Method
probabilistic
MBR-002260CLM-432498
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009704
Orphan claim re-pointed
Claims processor
CLM-416905 → UHC-90316-10 (Bobby Gutierrez)
Member id
UHC-90316-10
Confidence
1
Method
probabilistic
MBR-015564CLM-416905
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009705
Orphan claim re-pointed
Claims processor
CLM-406869 → UHC-61614-40 (Virginia Carr)
Member id
UHC-61614-40
Confidence
1
Method
probabilistic
MBR-012558CLM-406869
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009706
Orphan claim re-pointed
Claims processor
CLM-418609 → UHC-43502-22 (Albert Burke)
Member id
UHC-43502-22
Confidence
1
Method
probabilistic
MBR-004970CLM-418609
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009707
Orphan claim re-pointed
Claims processor
CLM-412339 → UHC-25749-79 (Judy Cooper)
Member id
UHC-25749-79
Confidence
1
Method
probabilistic
MBR-020170CLM-412339
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009708
Orphan claim re-pointed
Claims processor
CLM-415940 → UHC-99093-54 (Albert Johnston)
Member id
UHC-99093-54
Confidence
1
Method
probabilistic
MBR-004403CLM-415940
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009709
Orphan claim re-pointed
Claims processor
CLM-404504 → UHC-39290-43 (Juan Morrison)
Member id
UHC-39290-43
Confidence
0.99
Method
probabilistic
MBR-025219CLM-404504
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009710
Orphan claim re-pointed
Claims processor
CLM-409588 → UHC-40919-31 (Donald Vazquez)
Member id
UHC-40919-31
Confidence
0.92
Method
probabilistic
MBR-017076CLM-409588
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009711
Orphan claim re-pointed
Claims processor
CLM-429866 → UHC-33407-76 (Carol Ruiz)
Member id
UHC-33407-76
Confidence
1
Method
probabilistic
MBR-023943CLM-429866
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009712
Orphan claim re-pointed
Claims processor
CLM-401344 → UHC-85563-72 (Sara Kelly)
Member id
UHC-85563-72
Confidence
0.97
Method
deterministic
MBR-015159CLM-401344
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009713
Orphan claim re-pointed
Claims processor
CLM-405906 → UHC-84386-45 (Gregory Webb)
Member id
UHC-84386-45
Confidence
1
Method
probabilistic
MBR-005636CLM-405906
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009714
Orphan claim re-pointed
Claims processor
CLM-409927 → UHC-52699-22 (Brittany Crawford)
Member id
UHC-52699-22
Confidence
1
Method
probabilistic
MBR-031959CLM-409927
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009715
Orphan claim re-pointed
Claims processor
CLM-421974 → UHC-16147-23 (Kyle Woods)
Member id
UHC-16147-23
Confidence
1
Method
probabilistic
MBR-008721CLM-421974
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009716
Orphan claim re-pointed
Claims processor
CLM-432280 → UHC-24206-61 (Amanda Bennett)
Member id
UHC-24206-61
Confidence
1
Method
probabilistic
MBR-029390CLM-432280
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009717
Orphan claim re-pointed
Claims processor
CLM-401908 → UHC-29088-65 (Walter Harvey)
Member id
UHC-29088-65
Confidence
0.99
Method
probabilistic
MBR-028408CLM-401908
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009718
Orphan claim re-pointed
Claims processor
CLM-423069 → UHC-99771-23 (Nathan Riley)
Member id
UHC-99771-23
Confidence
0.99
Method
probabilistic
MBR-006339CLM-423069
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009719
Orphan claim re-pointed
Claims processor
CLM-408566 → UHC-53874-23 (Janet Carroll)
Member id
UHC-53874-23
Confidence
1
Method
probabilistic
MBR-022901CLM-408566
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009720
Orphan claim re-pointed
Claims processor
CLM-422047 → UHC-89227-34 (Carlos Campbell)
Member id
UHC-89227-34
Confidence
1
Method
probabilistic
MBR-008494CLM-422047
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009721
Orphan claim re-pointed
Claims processor
CLM-414756 → UHC-87599-06 (Sandra Simmons)
Member id
UHC-87599-06
Confidence
0.97
Method
deterministic
MBR-029877CLM-414756
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009722
Orphan claim re-pointed
Claims processor
CLM-420706 → UHC-73110-21 (Peter Jenkins)
Member id
UHC-73110-21
Confidence
0.89
Method
probabilistic
MBR-014628CLM-420706
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009723
Orphan claim re-pointed
Claims processor
CLM-419558 → UHC-69511-69 (Rachel Wagner)
Member id
UHC-69511-69
Confidence
0.97
Method
deterministic
MBR-029814CLM-419558
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009724
Orphan claim re-pointed
Claims processor
CLM-405002 → UHC-32929-28 (Julia Meyer)
Member id
UHC-32929-28
Confidence
0.97
Method
deterministic
MBR-026680CLM-405002
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009725
Orphan claim re-pointed
Claims processor
CLM-415919 → UHC-84155-80 (Karen Montgomery)
Member id
UHC-84155-80
Confidence
1
Method
probabilistic
MBR-008254CLM-415919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009726
Orphan claim re-pointed
Claims processor
CLM-413237 → UHC-46471-24 (Ahmed Bailey)
Member id
UHC-46471-24
Confidence
0.99
Method
probabilistic
MBR-030022CLM-413237
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009727
Orphan claim re-pointed
Claims processor
CLM-404240 → UHC-86120-37 (Martha Romero)
Member id
UHC-86120-37
Confidence
0.93
Method
probabilistic
MBR-026232CLM-404240
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009728
Orphan claim re-pointed
Claims processor
CLM-425353 → UHC-18597-75 (Isabella Lynch)
Member id
UHC-18597-75
Confidence
1.00
Method
probabilistic
MBR-010686CLM-425353
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009729
Orphan claim re-pointed
Claims processor
CLM-402437 → UHC-55403-36 (Denise Perkins)
Member id
UHC-55403-36
Confidence
0.97
Method
deterministic
MBR-006030CLM-402437
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009730
Orphan claim re-pointed
Claims processor
CLM-416223 → UHC-93006-69 (Donna Edwards)
Member id
UHC-93006-69
Confidence
1
Method
probabilistic
MBR-014853CLM-416223
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009731
Orphan claim re-pointed
Claims processor
CLM-416699 → UHC-75227-62 (Luis Delgado)
Member id
UHC-75227-62
Confidence
1
Method
probabilistic
MBR-030893CLM-416699
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009732
Orphan claim re-pointed
Claims processor
CLM-404918 → UHC-88136-88 (Cheryl Bryant)
Member id
UHC-88136-88
Confidence
1
Method
probabilistic
MBR-027193CLM-404918
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009733
Orphan claim re-pointed
Claims processor
CLM-427977 → UHC-19292-41 (Ruth Jones)
Member id
UHC-19292-41
Confidence
0.99
Method
probabilistic
MBR-013850CLM-427977
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009734
Orphan claim re-pointed
Claims processor
CLM-420218 → UHC-39537-44 (Logan Park)
Member id
UHC-39537-44
Confidence
0.98
Method
probabilistic
MBR-011978CLM-420218
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009735
Orphan claim re-pointed
Claims processor
CLM-406097 → UHC-55420-11 (Alan Tran)
Member id
UHC-55420-11
Confidence
1
Method
probabilistic
MBR-019893CLM-406097
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009736
Orphan claim re-pointed
Claims processor
CLM-405223 → UHC-28414-39 (Lsa Welch)
Member id
UHC-28414-39
Confidence
0.98
Method
probabilistic
MBR-011775CLM-405223
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009737
Orphan claim re-pointed
Claims processor
CLM-406879 → UHC-12515-95 (Ana Gibson)
Member id
UHC-12515-95
Confidence
0.99
Method
probabilistic
MBR-009099CLM-406879
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009738
Orphan claim re-pointed
Claims processor
CLM-405232 → UHC-52836-55 (Victoria Hawkins)
Member id
UHC-52836-55
Confidence
1
Method
probabilistic
MBR-018388CLM-405232
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009739
Orphan claim re-pointed
Claims processor
CLM-411641 → UHC-09388-80 (Jason Moreno)
Member id
UHC-09388-80
Confidence
1
Method
probabilistic
MBR-023010CLM-411641
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 168 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.