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-010390
Orphan claim re-pointed
Claims processor
CLM-415603 → UHC-44443-96 (Jacqueline Gonzales)
Member id
UHC-44443-96
Confidence
1
Method
probabilistic
MBR-019371CLM-415603
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010391
Orphan claim re-pointed
Claims processor
CLM-410293 → UHC-47039-85 (Emma Campbell)
Member id
UHC-47039-85
Confidence
0.99
Method
probabilistic
MBR-025182CLM-410293
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010392
Orphan claim re-pointed
Claims processor
CLM-418146 → UHC-72529-98 (Vincent Thomas)
Member id
UHC-72529-98
Confidence
0.99
Method
probabilistic
MBR-008558CLM-418146
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010393
Orphan claim re-pointed
Claims processor
CLM-405657 → UHC-10864-53 (Kathryn Powell)
Member id
UHC-10864-53
Confidence
0.99
Method
probabilistic
MBR-004898CLM-405657
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010394
Orphan claim re-pointed
Claims processor
CLM-429218 → UHC-53835-71 (Camila Hunter)
Member id
UHC-53835-71
Confidence
0.97
Method
deterministic
MBR-004976CLM-429218
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010395
Orphan claim re-pointed
Claims processor
CLM-429963 → UHC-13305-47 (Betty Sandoval)
Member id
UHC-13305-47
Confidence
1
Method
probabilistic
MBR-023917CLM-429963
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010396
Orphan claim re-pointed
Claims processor
CLM-402349 → UHC-68685-92 (Mary Allen)
Member id
UHC-68685-92
Confidence
0.97
Method
deterministic
MBR-002549CLM-402349
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010397
Orphan claim re-pointed
Claims processor
CLM-426503 → UHC-02668-55 (Jesse Delgado)
Member id
UHC-02668-55
Confidence
1
Method
probabilistic
MBR-014174CLM-426503
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010398
Orphan claim re-pointed
Claims processor
CLM-410198 → UHC-12801-77 (Arthur Alvarez)
Member id
UHC-12801-77
Confidence
0.97
Method
deterministic
MBR-013686CLM-410198
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010399
Orphan claim re-pointed
Claims processor
CLM-426000 → UHC-96758-59 (Jason Price)
Member id
UHC-96758-59
Confidence
1
Method
probabilistic
MBR-000456CLM-426000
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010400
Orphan claim re-pointed
Claims processor
CLM-404932 → UHC-49707-14 (Catherine Garcia)
Member id
UHC-49707-14
Confidence
0.97
Method
deterministic
MBR-017555CLM-404932
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010401
Orphan claim re-pointed
Claims processor
CLM-419276 → UHC-48755-05 (Alice Rojas)
Member id
UHC-48755-05
Confidence
0.97
Method
deterministic
MBR-011040CLM-419276
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010402
Orphan claim re-pointed
Claims processor
CLM-427260 → UHC-92494-52 (Mary Coleman)
Member id
UHC-92494-52
Confidence
1
Method
probabilistic
MBR-004523CLM-427260
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010403
Orphan claim re-pointed
Claims processor
CLM-413619 → UHC-37470-27 (Henry Castillo)
Member id
UHC-37470-27
Confidence
1
Method
probabilistic
MBR-002652CLM-413619
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010404
Orphan claim re-pointed
Claims processor
CLM-412848 → UHC-38547-86 (Kathleen Butler)
Member id
UHC-38547-86
Confidence
1
Method
probabilistic
MBR-009402CLM-412848
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010405
Orphan claim re-pointed
Claims processor
CLM-428508 → UHC-55442-75 (Frank Lawrence)
Member id
UHC-55442-75
Confidence
1
Method
probabilistic
MBR-001924CLM-428508
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010406
Orphan claim re-pointed
Claims processor
CLM-422964 → UHC-63040-61 (Kevin Hicks)
Member id
UHC-63040-61
Confidence
1
Method
probabilistic
MBR-012469CLM-422964
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010407
Orphan claim re-pointed
Claims processor
CLM-428604 → UHC-14029-74 (Kathleen Carr)
Member id
UHC-14029-74
Confidence
1
Method
probabilistic
MBR-006388CLM-428604
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010408
Orphan claim re-pointed
Claims processor
CLM-400920 → UHC-61532-06 (Catherine Hoffman)
Member id
UHC-61532-06
Confidence
1
Method
probabilistic
MBR-018829CLM-400920
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010409
Orphan claim re-pointed
Claims processor
CLM-429043 → UHC-02558-95 (Raymond Mason)
Member id
UHC-02558-95
Confidence
0.97
Method
deterministic
MBR-018371CLM-429043
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010410
Orphan claim re-pointed
Claims processor
CLM-432773 → UHC-20259-21 (Steve Marquez)
Member id
UHC-20259-21
Confidence
1
Method
probabilistic
MBR-003381CLM-432773
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010411
Orphan claim re-pointed
Claims processor
CLM-429063 → UHC-19184-04 (Michael Mills)
Member id
UHC-19184-04
Confidence
1
Method
probabilistic
MBR-009287CLM-429063
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010412
Orphan claim re-pointed
Claims processor
CLM-427106 → UHC-19076-64 (Roy Hunt)
Member id
UHC-19076-64
Confidence
1
Method
probabilistic
MBR-003460CLM-427106
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010413
Orphan claim re-pointed
Claims processor
CLM-427403 → UHC-56502-17 (Adam Richards)
Member id
UHC-56502-17
Confidence
1
Method
probabilistic
MBR-000812CLM-427403
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010414
Orphan claim re-pointed
Claims processor
CLM-402626 → UHC-65967-67 (Alan Gardner)
Member id
UHC-65967-67
Confidence
0.97
Method
deterministic
MBR-013235CLM-402626
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010415
Orphan claim re-pointed
Claims processor
CLM-428820 → UHC-14709-71 (Eric Shaw)
Member id
UHC-14709-71
Confidence
0.99
Method
probabilistic
MBR-018476CLM-428820
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010416
Orphan claim re-pointed
Claims processor
CLM-412471 → UHC-68258-71 (Emily Harrison)
Member id
UHC-68258-71
Confidence
1
Method
probabilistic
MBR-019763CLM-412471
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010417
Orphan claim re-pointed
Claims processor
CLM-427755 → UHC-62790-30 (Jordan Flores)
Member id
UHC-62790-30
Confidence
1
Method
probabilistic
MBR-004264CLM-427755
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010418
Orphan claim re-pointed
Claims processor
CLM-416668 → UHC-28244-02 (Samantha Henderson)
Member id
UHC-28244-02
Confidence
1.00
Method
probabilistic
MBR-022562CLM-416668
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010419
Orphan claim re-pointed
Claims processor
CLM-421381 → UHC-42228-14 (Rebecca Murray)
Member id
UHC-42228-14
Confidence
0.97
Method
deterministic
MBR-023567CLM-421381
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010420
Orphan claim re-pointed
Claims processor
CLM-422305 → UHC-98490-89 (Kayla Walsh)
Member id
UHC-98490-89
Confidence
1
Method
probabilistic
MBR-008962CLM-422305
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010421
Orphan claim re-pointed
Claims processor
CLM-416601 → UHC-62349-08 (Logan Bailey)
Member id
UHC-62349-08
Confidence
0.99
Method
probabilistic
MBR-001890CLM-416601
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010422
Orphan claim re-pointed
Claims processor
CLM-426602 → UHC-42124-69 (Christopher Simmons)
Member id
UHC-42124-69
Confidence
0.97
Method
deterministic
MBR-018543CLM-426602
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010423
Orphan claim re-pointed
Claims processor
CLM-403668 → UHC-13416-25 (Keneth Schultz)
Member id
UHC-13416-25
Confidence
0.99
Method
probabilistic
MBR-009846CLM-403668
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010424
Orphan claim re-pointed
Claims processor
CLM-431260 → UHC-03024-42 (Steven Medina)
Member id
UHC-03024-42
Confidence
0.97
Method
deterministic
MBR-004979CLM-431260
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010425
Orphan claim re-pointed
Claims processor
CLM-432813 → UHC-49399-41 (Valentina Jacobs)
Member id
UHC-49399-41
Confidence
1
Method
probabilistic
MBR-018636CLM-432813
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010426
Orphan claim re-pointed
Claims processor
CLM-401216 → UHC-81823-63 (Ethan Maldonado)
Member id
UHC-81823-63
Confidence
0.93
Method
probabilistic
MBR-020364CLM-401216
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010427
Orphan claim re-pointed
Claims processor
CLM-422406 → UHC-41876-71 (Stephanie Williamson)
Member id
UHC-41876-71
Confidence
1
Method
probabilistic
MBR-011012CLM-422406
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010428
Orphan claim re-pointed
Claims processor
CLM-403687 → UHC-66180-38 (Willie Medina)
Member id
UHC-66180-38
Confidence
1
Method
probabilistic
MBR-013919CLM-403687
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010429
Orphan claim re-pointed
Claims processor
CLM-414829 → UHC-17569-05 (Henry Perkins)
Member id
UHC-17569-05
Confidence
0.99
Method
probabilistic
MBR-000833CLM-414829
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010430
Orphan claim re-pointed
Claims processor
CLM-430487 → UHC-82518-76 (Sarah Sanchez)
Member id
UHC-82518-76
Confidence
1
Method
probabilistic
MBR-017544CLM-430487
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010431
Orphan claim re-pointed
Claims processor
CLM-401366 → UHC-86812-10 (Angela Hawkins)
Member id
UHC-86812-10
Confidence
1
Method
probabilistic
MBR-002138CLM-401366
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010432
Orphan claim re-pointed
Claims processor
CLM-420900 → UHC-01992-56 (Elizabeth Schultz)
Member id
UHC-01992-56
Confidence
0.86
Method
probabilistic
MBR-030535CLM-420900
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010433
Orphan claim re-pointed
Claims processor
CLM-414502 → UHC-26652-20 (Brandon Torres)
Member id
UHC-26652-20
Confidence
1
Method
probabilistic
MBR-009781CLM-414502
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010434
Orphan claim re-pointed
Claims processor
CLM-403709 → UHC-01356-46 (Keith Vazquez)
Member id
UHC-01356-46
Confidence
1
Method
probabilistic
MBR-012139CLM-403709
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010435
Orphan claim re-pointed
Claims processor
CLM-420931 → UHC-14343-17 (Theresa Parker)
Member id
UHC-14343-17
Confidence
1
Method
probabilistic
MBR-011124CLM-420931
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010436
Orphan claim re-pointed
Claims processor
CLM-421374 → UHC-79512-87 (Frances Grant)
Member id
UHC-79512-87
Confidence
1
Method
probabilistic
MBR-010555CLM-421374
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010437
Orphan claim re-pointed
Claims processor
CLM-417434 → UHC-20657-68 (Vicky Hamilton)
Member id
UHC-20657-68
Confidence
1
Method
probabilistic
MBR-002760CLM-417434
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010438
Orphan claim re-pointed
Claims processor
CLM-409389 → UHC-56774-67 (Zachary Perkins)
Member id
UHC-56774-67
Confidence
1
Method
probabilistic
MBR-016227CLM-409389
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010439
Orphan claim re-pointed
Claims processor
CLM-430802 → UHC-80095-34 (Marilyn Castillo)
Member id
UHC-80095-34
Confidence
0.93
Method
probabilistic
MBR-000896CLM-430802
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 182 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.