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-009890
Orphan claim re-pointed
Claims processor
CLM-426124 → UHC-41254-21 (Logan Lucas)
Member id
UHC-41254-21
Confidence
1
Method
probabilistic
MBR-025515CLM-426124
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009891
Orphan claim re-pointed
Claims processor
CLM-409246 → UHC-42045-03 (Pamela Simpson)
Member id
UHC-42045-03
Confidence
0.97
Method
deterministic
MBR-029041CLM-409246
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009892
Orphan claim re-pointed
Claims processor
CLM-431759 → UHC-17325-49 (Peter Green)
Member id
UHC-17325-49
Confidence
1
Method
probabilistic
MBR-003631CLM-431759
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009893
Orphan claim re-pointed
Claims processor
CLM-413139 → UHC-33926-12 (John Gomez)
Member id
UHC-33926-12
Confidence
0.97
Method
deterministic
MBR-010932CLM-413139
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009894
Orphan claim re-pointed
Claims processor
CLM-401379 → UHC-13802-06 (Carol Powell)
Member id
UHC-13802-06
Confidence
0.97
Method
deterministic
MBR-022371CLM-401379
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009895
Orphan claim re-pointed
Claims processor
CLM-401375 → UHC-37002-76 (Ahmed Lane)
Member id
UHC-37002-76
Confidence
1
Method
probabilistic
MBR-014791CLM-401375
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009896
Orphan claim re-pointed
Claims processor
CLM-415755 → UHC-34186-32 (Nicole Daniels)
Member id
UHC-34186-32
Confidence
1
Method
probabilistic
MBR-008228CLM-415755
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009897
Orphan claim re-pointed
Claims processor
CLM-403514 → UHC-24064-83 (Ronald Alvarado)
Member id
UHC-24064-83
Confidence
1
Method
probabilistic
MBR-010367CLM-403514
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009898
Orphan claim re-pointed
Claims processor
CLM-427242 → UHC-47675-96 (Stephen Carter)
Member id
UHC-47675-96
Confidence
1
Method
probabilistic
MBR-026324CLM-427242
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009899
Orphan claim re-pointed
Claims processor
CLM-423920 → UHC-17176-96 (Ralph Burke)
Member id
UHC-17176-96
Confidence
1
Method
probabilistic
MBR-037057CLM-423920
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009900
Orphan claim re-pointed
Claims processor
CLM-403475 → UHC-95401-16 (Kathryn Pierce)
Member id
UHC-95401-16
Confidence
0.99
Method
probabilistic
MBR-006669CLM-403475
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009901
Orphan claim re-pointed
Claims processor
CLM-400761 → UHC-98621-01 (Ruth Taylor)
Member id
UHC-98621-01
Confidence
1
Method
probabilistic
MBR-006206CLM-400761
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009902
Orphan claim re-pointed
Claims processor
CLM-415482 → UHC-09218-86 (Catherine Lawrence)
Member id
UHC-09218-86
Confidence
1
Method
probabilistic
MBR-013253CLM-415482
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009903
Orphan claim re-pointed
Claims processor
CLM-412223 → UHC-78896-26 (Priya Henry)
Member id
UHC-78896-26
Confidence
0.97
Method
deterministic
MBR-029030CLM-412223
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009904
Orphan claim re-pointed
Claims processor
CLM-425841 → UHC-82624-24 (Dorothy Wang)
Member id
UHC-82624-24
Confidence
1
Method
probabilistic
MBR-007912CLM-425841
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009905
Orphan claim re-pointed
Claims processor
CLM-424231 → UHC-82341-82 (Stephanie Porter)
Member id
UHC-82341-82
Confidence
1
Method
probabilistic
MBR-005935CLM-424231
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009906
Orphan claim re-pointed
Claims processor
CLM-424142 → UHC-49248-34 (Gabriel Wood)
Member id
UHC-49248-34
Confidence
1
Method
probabilistic
MBR-037202CLM-424142
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009907
Orphan claim re-pointed
Claims processor
CLM-428568 → UHC-59290-66 (Kimberly Harvey)
Member id
UHC-59290-66
Confidence
0.97
Method
deterministic
MBR-009522CLM-428568
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009908
Orphan claim re-pointed
Claims processor
CLM-425455 → UHC-53924-24 (Laura Obrien)
Member id
UHC-53924-24
Confidence
1
Method
probabilistic
MBR-002945CLM-425455
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009909
Orphan claim re-pointed
Claims processor
CLM-406191 → UHC-12037-69 (Gabriel Brown)
Member id
UHC-12037-69
Confidence
1
Method
probabilistic
MBR-011307CLM-406191
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009910
Orphan claim re-pointed
Claims processor
CLM-403773 → UHC-91293-76 (Bryan Guerrero)
Member id
UHC-91293-76
Confidence
1
Method
probabilistic
MBR-021623CLM-403773
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009911
Orphan claim re-pointed
Claims processor
CLM-411254 → UHC-14318-72 (Gabriel Gray)
Member id
UHC-14318-72
Confidence
0.97
Method
deterministic
MBR-016583CLM-411254
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009912
Orphan claim re-pointed
Claims processor
CLM-411956 → UHC-27814-80 (Henry Alvarez)
Member id
UHC-27814-80
Confidence
1
Method
probabilistic
MBR-031104CLM-411956
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009913
Orphan claim re-pointed
Claims processor
CLM-401168 → UHC-62794-28 (Maria Carroll)
Member id
UHC-62794-28
Confidence
1
Method
probabilistic
MBR-005563CLM-401168
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009914
Orphan claim re-pointed
Claims processor
CLM-425553 → UHC-52127-72 (Emily White)
Member id
UHC-52127-72
Confidence
1
Method
probabilistic
MBR-001035CLM-425553
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009915
Orphan claim re-pointed
Claims processor
CLM-427309 → UHC-55595-27 (Patricia Adams)
Member id
UHC-55595-27
Confidence
0.99
Method
probabilistic
MBR-013261CLM-427309
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009916
Orphan claim re-pointed
Claims processor
CLM-402563 → UHC-95810-35 (Karen Johnston)
Member id
UHC-95810-35
Confidence
1
Method
probabilistic
MBR-035952CLM-402563
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009917
Orphan claim re-pointed
Claims processor
CLM-417686 → UHC-45514-20 (Jack Lawson)
Member id
UHC-45514-20
Confidence
1
Method
probabilistic
MBR-038445CLM-417686
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009918
Orphan claim re-pointed
Claims processor
CLM-424046 → UHC-22131-74 (Henry Ross)
Member id
UHC-22131-74
Confidence
1
Method
probabilistic
MBR-037949CLM-424046
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009919
Orphan claim re-pointed
Claims processor
CLM-401717 → UHC-60493-89 (Camila James)
Member id
UHC-60493-89
Confidence
0.99
Method
probabilistic
MBR-005539CLM-401717
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009920
Orphan claim re-pointed
Claims processor
CLM-420754 → UHC-94810-45 (Ashley Walker)
Member id
UHC-94810-45
Confidence
1
Method
probabilistic
MBR-012508CLM-420754
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009921
Orphan claim re-pointed
Claims processor
CLM-400231 → UHC-55219-48 (Austin Stone)
Member id
UHC-55219-48
Confidence
0.97
Method
deterministic
MBR-019088CLM-400231
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009922
Orphan claim re-pointed
Claims processor
CLM-407536 → UHC-53993-88 (Jose Silva)
Member id
UHC-53993-88
Confidence
0.99
Method
probabilistic
MBR-036010CLM-407536
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009923
Orphan claim re-pointed
Claims processor
CLM-402798 → UHC-94418-36 (Jose Alvarez)
Member id
UHC-94418-36
Confidence
1
Method
probabilistic
MBR-019955CLM-402798
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009924
Orphan claim re-pointed
Claims processor
CLM-402158 → UHC-54463-75 (Richard Barnes)
Member id
UHC-54463-75
Confidence
0.93
Method
probabilistic
MBR-018787CLM-402158
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009925
Orphan claim re-pointed
Claims processor
CLM-411177 → UHC-84331-08 (Victoria Padilla)
Member id
UHC-84331-08
Confidence
1
Method
probabilistic
MBR-011844CLM-411177
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009926
Orphan claim re-pointed
Claims processor
CLM-411027 → UHC-45537-10 (Sara Andrews)
Member id
UHC-45537-10
Confidence
1
Method
probabilistic
MBR-034288CLM-411027
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009927
Orphan claim re-pointed
Claims processor
CLM-427668 → UHC-06238-41 (Josh Hudson)
Member id
UHC-06238-41
Confidence
0.99
Method
probabilistic
MBR-019744CLM-427668
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009928
Orphan claim re-pointed
Claims processor
CLM-426612 → UHC-55922-83 (Elizabeth Reed)
Member id
UHC-55922-83
Confidence
0.94
Method
probabilistic
MBR-033087CLM-426612
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009929
Orphan claim re-pointed
Claims processor
CLM-425470 → UHC-53604-06 (Steven Ramos)
Member id
UHC-53604-06
Confidence
1
Method
probabilistic
MBR-008981CLM-425470
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009930
Orphan claim re-pointed
Claims processor
CLM-416809 → UHC-94131-80 (Janet Cruz)
Member id
UHC-94131-80
Confidence
1
Method
probabilistic
MBR-004760CLM-416809
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009931
Orphan claim re-pointed
Claims processor
CLM-403265 → UHC-07851-61 (Keith Price)
Member id
UHC-07851-61
Confidence
1
Method
probabilistic
MBR-026831CLM-403265
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009932
Orphan claim re-pointed
Claims processor
CLM-412360 → UHC-80875-48 (Janice Hanson)
Member id
UHC-80875-48
Confidence
1
Method
probabilistic
MBR-011355CLM-412360
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009933
Orphan claim re-pointed
Claims processor
CLM-428051 → UHC-49331-36 (Ethan Williamson)
Member id
UHC-49331-36
Confidence
0.93
Method
probabilistic
MBR-021932CLM-428051
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009934
Orphan claim re-pointed
Claims processor
CLM-419218 → UHC-20139-14 (Alice Gordon)
Member id
UHC-20139-14
Confidence
1
Method
probabilistic
MBR-018449CLM-419218
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009935
Orphan claim re-pointed
Claims processor
CLM-422157 → UHC-48315-62 (James Reid)
Member id
UHC-48315-62
Confidence
1
Method
probabilistic
MBR-010522CLM-422157
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009936
Orphan claim re-pointed
Claims processor
CLM-406669 → UHC-02515-86 (Jean Brown)
Member id
UHC-02515-86
Confidence
0.99
Method
probabilistic
MBR-014873CLM-406669
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009937
Orphan claim re-pointed
Claims processor
CLM-428890 → UHC-82069-96 (Helen Woods)
Member id
UHC-82069-96
Confidence
1
Method
probabilistic
MBR-019441CLM-428890
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009938
Orphan claim re-pointed
Claims processor
CLM-431394 → UHC-93292-52 (Diana Williamson)
Member id
UHC-93292-52
Confidence
1
Method
probabilistic
MBR-023689CLM-431394
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009939
Orphan claim re-pointed
Claims processor
CLM-431998 → UHC-24782-47 (Ralph Mejia)
Member id
UHC-24782-47
Confidence
1
Method
probabilistic
MBR-027172CLM-431998
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 172 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.