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-009790
Orphan claim re-pointed
Claims processor
CLM-425473 → UHC-33599-32 (Sean Young)
Member id
UHC-33599-32
Confidence
0.98
Method
probabilistic
MBR-024788CLM-425473
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009791
Orphan claim re-pointed
Claims processor
CLM-406195 → UHC-00138-75 (Fatima Perkins)
Member id
UHC-00138-75
Confidence
1
Method
probabilistic
MBR-002285CLM-406195
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009792
Orphan claim re-pointed
Claims processor
CLM-414610 → UHC-55711-88 (Kathy Garrett)
Member id
UHC-55711-88
Confidence
0.97
Method
deterministic
MBR-023059CLM-414610
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009793
Orphan claim re-pointed
Claims processor
CLM-430820 → UHC-68161-24 (Timothy Edwards)
Member id
UHC-68161-24
Confidence
1
Method
probabilistic
MBR-003875CLM-430820
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009794
Orphan claim re-pointed
Claims processor
CLM-430111 → UHC-01242-71 (Frank Yang)
Member id
UHC-01242-71
Confidence
1
Method
probabilistic
MBR-015607CLM-430111
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009795
Orphan claim re-pointed
Claims processor
CLM-418153 → UHC-63645-91 (Harold Mejia)
Member id
UHC-63645-91
Confidence
0.99
Method
probabilistic
MBR-009130CLM-418153
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009796
Orphan claim re-pointed
Claims processor
CLM-415041 → UHC-63870-54 (Ronald Evans)
Member id
UHC-63870-54
Confidence
0.97
Method
deterministic
MBR-017762CLM-415041
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009797
Orphan claim re-pointed
Claims processor
CLM-417230 → UHC-88955-23 (Andrea Anderson)
Member id
UHC-88955-23
Confidence
1
Method
probabilistic
MBR-018844CLM-417230
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009798
Orphan claim re-pointed
Claims processor
CLM-411622 → UHC-88620-39 (Brandon Park)
Member id
UHC-88620-39
Confidence
1
Method
probabilistic
MBR-025220CLM-411622
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009799
Orphan claim re-pointed
Claims processor
CLM-405441 → UHC-00989-26 (Diana Washington)
Member id
UHC-00989-26
Confidence
0.97
Method
deterministic
MBR-034371CLM-405441
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009800
Orphan claim re-pointed
Claims processor
CLM-410913 → UHC-70981-11 (Diana Chapman)
Member id
UHC-70981-11
Confidence
0.98
Method
probabilistic
MBR-021218CLM-410913
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009801
Orphan claim re-pointed
Claims processor
CLM-421924 → UHC-34912-88 (Theresa Henry)
Member id
UHC-34912-88
Confidence
0.86
Method
probabilistic
MBR-016456CLM-421924
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009802
Orphan claim re-pointed
Claims processor
CLM-428862 → UHC-46807-70 (Arthur Johnson)
Member id
UHC-46807-70
Confidence
0.97
Method
deterministic
MBR-000062CLM-428862
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009803
Orphan claim re-pointed
Claims processor
CLM-418385 → UHC-94457-68 (David Larson)
Member id
UHC-94457-68
Confidence
0.97
Method
deterministic
MBR-030109CLM-418385
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009804
Orphan claim re-pointed
Claims processor
CLM-412693 → UHC-07446-40 (Isabella Torres)
Member id
UHC-07446-40
Confidence
1
Method
probabilistic
MBR-017706CLM-412693
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009805
Orphan claim re-pointed
Claims processor
CLM-407374 → UHC-52585-76 (Santiago Elliott)
Member id
UHC-52585-76
Confidence
1
Method
probabilistic
MBR-025676CLM-407374
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009806
Orphan claim re-pointed
Claims processor
CLM-420981 → UHC-63371-59 (Andrew Fernandez)
Member id
UHC-63371-59
Confidence
1
Method
probabilistic
MBR-033159CLM-420981
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009807
Orphan claim re-pointed
Claims processor
CLM-421869 → UHC-92926-86 (Brenda Grant)
Member id
UHC-92926-86
Confidence
1
Method
probabilistic
MBR-004821CLM-421869
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009808
Orphan claim re-pointed
Claims processor
CLM-414997 → UHC-13776-69 (Anthony Wilson)
Member id
UHC-13776-69
Confidence
1
Method
probabilistic
MBR-043147CLM-414997
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009809
Orphan claim re-pointed
Claims processor
CLM-412333 → UHC-82124-06 (Keith McDonald)
Member id
UHC-82124-06
Confidence
1
Method
probabilistic
MBR-001232CLM-412333
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009810
Orphan claim re-pointed
Claims processor
CLM-424838 → UHC-05807-14 (James Tran)
Member id
UHC-05807-14
Confidence
1
Method
probabilistic
MBR-040370CLM-424838
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009811
Orphan claim re-pointed
Claims processor
CLM-406493 → UHC-97310-50 (Luis Reed)
Member id
UHC-97310-50
Confidence
1
Method
probabilistic
MBR-011107CLM-406493
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009812
Orphan claim re-pointed
Claims processor
CLM-405546 → UHC-96787-07 (Katherine Ramos)
Member id
UHC-96787-07
Confidence
1.00
Method
probabilistic
MBR-014260CLM-405546
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009813
Orphan claim re-pointed
Claims processor
CLM-410045 → UHC-92857-60 (Sean Sean)
Member id
UHC-92857-60
Confidence
0.99
Method
probabilistic
MBR-026455CLM-410045
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009814
Orphan claim re-pointed
Claims processor
CLM-422224 → UHC-83444-60 (Billy Morales)
Member id
UHC-83444-60
Confidence
0.97
Method
deterministic
MBR-013536CLM-422224
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009815
Orphan claim re-pointed
Claims processor
CLM-419833 → UHC-11708-31 (Albert Jacobs)
Member id
UHC-11708-31
Confidence
1
Method
probabilistic
MBR-000235CLM-419833
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009816
Orphan claim re-pointed
Claims processor
CLM-407983 → UHC-93859-39 (Sara Watson)
Member id
UHC-93859-39
Confidence
0.97
Method
deterministic
MBR-008589CLM-407983
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009817
Orphan claim re-pointed
Claims processor
CLM-400429 → UHC-60033-71 (Bradley Carroll)
Member id
UHC-60033-71
Confidence
1
Method
probabilistic
MBR-016939CLM-400429
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009818
Orphan claim re-pointed
Claims processor
CLM-400440 → UHC-48650-39 (Juan Castro)
Member id
UHC-48650-39
Confidence
0.98
Method
probabilistic
MBR-005801CLM-400440
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009819
Orphan claim re-pointed
Claims processor
CLM-426117 → UHC-81435-34 (Kathleen Bryant)
Member id
UHC-81435-34
Confidence
1
Method
probabilistic
MBR-037879CLM-426117
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009820
Orphan claim re-pointed
Claims processor
CLM-426386 → UHC-77668-48 (Linda Washington)
Member id
UHC-77668-48
Confidence
1
Method
probabilistic
MBR-026537CLM-426386
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009821
Orphan claim re-pointed
Claims processor
CLM-424755 → UHC-15768-95 (Christine Jensen)
Member id
UHC-15768-95
Confidence
1
Method
probabilistic
MBR-031772CLM-424755
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009822
Orphan claim re-pointed
Claims processor
CLM-424741 → UHC-10537-45 (Santiago Peterson)
Member id
UHC-10537-45
Confidence
1
Method
probabilistic
MBR-022962CLM-424741
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009823
Orphan claim re-pointed
Claims processor
CLM-417634 → UHC-93885-30 (Adam Ruiz)
Member id
UHC-93885-30
Confidence
1
Method
probabilistic
MBR-009057CLM-417634
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009824
Orphan claim re-pointed
Claims processor
CLM-426784 → UHC-75200-93 (Angela Ellis)
Member id
UHC-75200-93
Confidence
0.99
Method
probabilistic
MBR-007350CLM-426784
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009825
Orphan claim re-pointed
Claims processor
CLM-410323 → UHC-25496-41 (Tyler Perkins)
Member id
UHC-25496-41
Confidence
0.97
Method
deterministic
MBR-012672CLM-410323
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009826
Orphan claim re-pointed
Claims processor
CLM-425908 → UHC-17034-92 (Sarah Santos)
Member id
UHC-17034-92
Confidence
0.97
Method
deterministic
MBR-043007CLM-425908
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009827
Orphan claim re-pointed
Claims processor
CLM-409429 → UHC-43731-30 (Nancy Carr)
Member id
UHC-43731-30
Confidence
1
Method
probabilistic
MBR-011214CLM-409429
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009828
Orphan claim re-pointed
Claims processor
CLM-422410 → UHC-97279-29 (Joseph Carter)
Member id
UHC-97279-29
Confidence
1
Method
probabilistic
MBR-003844CLM-422410
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009829
Orphan claim re-pointed
Claims processor
CLM-407522 → UHC-46334-94 (Keith Nguyen)
Member id
UHC-46334-94
Confidence
1
Method
probabilistic
MBR-001045CLM-407522
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009830
Orphan claim re-pointed
Claims processor
CLM-404409 → UHC-78331-45 (Matthew White)
Member id
UHC-78331-45
Confidence
1
Method
probabilistic
MBR-001306CLM-404409
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009831
Orphan claim re-pointed
Claims processor
CLM-424514 → UHC-83159-99 (James Delgado)
Member id
UHC-83159-99
Confidence
1
Method
probabilistic
MBR-042384CLM-424514
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009832
Orphan claim re-pointed
Claims processor
CLM-407725 → UHC-99654-35 (Carlos Hamilton)
Member id
UHC-99654-35
Confidence
1
Method
probabilistic
MBR-010125CLM-407725
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009833
Orphan claim re-pointed
Claims processor
CLM-422291 → UHC-85073-69 (Logan Washington)
Member id
UHC-85073-69
Confidence
1
Method
probabilistic
MBR-041803CLM-422291
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009834
Orphan claim re-pointed
Claims processor
CLM-409785 → UHC-13667-19 (Mariana Stevens)
Member id
UHC-13667-19
Confidence
1
Method
probabilistic
MBR-005475CLM-409785
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009835
Orphan claim re-pointed
Claims processor
CLM-430967 → UHC-79600-13 (Frank Wright)
Member id
UHC-79600-13
Confidence
0.97
Method
deterministic
MBR-027640CLM-430967
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009836
Orphan claim re-pointed
Claims processor
CLM-422969 → UHC-80359-24 (Carol Pierce)
Member id
UHC-80359-24
Confidence
1
Method
probabilistic
MBR-011673CLM-422969
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009837
Orphan claim re-pointed
Claims processor
CLM-427417 → UHC-09454-42 (Karen Fowler)
Member id
UHC-09454-42
Confidence
1
Method
probabilistic
MBR-002592CLM-427417
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009838
Orphan claim re-pointed
Claims processor
CLM-431607 → UHC-47185-87 (Kelly Olson)
Member id
UHC-47185-87
Confidence
1
Method
probabilistic
MBR-005082CLM-431607
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009839
Orphan claim re-pointed
Claims processor
CLM-427766 → UHC-93261-88 (Anthony Harris)
Member id
UHC-93261-88
Confidence
1
Method
probabilistic
MBR-025039CLM-427766
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 170 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.