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-002690
Orphan claim re-pointed
Claims processor
CLM-406329 → UHC-91616-29 (Susan Cruz)
Member id
UHC-91616-29
Confidence
1
Method
probabilistic
MBR-014172CLM-406329
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002691
Orphan claim re-pointed
Claims processor
CLM-425469 → UHC-53604-06 (Steven Ramos)
Member id
UHC-53604-06
Confidence
1
Method
probabilistic
MBR-008981CLM-425469
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002692
Orphan claim re-pointed
Claims processor
CLM-429993 → UHC-17287-55 (Terry Henderson)
Member id
UHC-17287-55
Confidence
0.97
Method
deterministic
MBR-010560CLM-429993
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002693
Orphan claim re-pointed
Claims processor
CLM-400729 → UHC-76291-34 (Jacob Grant)
Member id
UHC-76291-34
Confidence
1
Method
probabilistic
MBR-020476CLM-400729
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002694
Orphan claim re-pointed
Claims processor
CLM-418295 → UHC-97403-22 (Angela Matthews)
Member id
UHC-97403-22
Confidence
1
Method
probabilistic
MBR-031136CLM-418295
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002695
Orphan claim re-pointed
Claims processor
CLM-416236 → UHC-02195-39 (Gloria Harper)
Member id
UHC-02195-39
Confidence
0.99
Method
probabilistic
MBR-014309CLM-416236
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002696
Orphan claim re-pointed
Claims processor
CLM-432609 → UHC-25299-76 (Christina Williams)
Member id
UHC-25299-76
Confidence
1
Method
probabilistic
MBR-028438CLM-432609
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002697
Orphan claim re-pointed
Claims processor
CLM-406300 → UHC-68741-60 (Joyce Palmer)
Member id
UHC-68741-60
Confidence
1
Method
probabilistic
MBR-003453CLM-406300
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002698
Orphan claim re-pointed
Claims processor
CLM-402802 → UHC-56451-68 (Kimberly Rios)
Member id
UHC-56451-68
Confidence
1
Method
probabilistic
MBR-030597CLM-402802
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002699
Orphan claim re-pointed
Claims processor
CLM-403067 → UHC-67952-99 (Alexis Garza)
Member id
UHC-67952-99
Confidence
1
Method
probabilistic
MBR-015676CLM-403067
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002700
Orphan claim re-pointed
Claims processor
CLM-423662 → UHC-58068-44 (Bobby Luna)
Member id
UHC-58068-44
Confidence
1
Method
probabilistic
MBR-019073CLM-423662
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002701
Orphan claim re-pointed
Claims processor
CLM-416134 → UHC-67936-93 (Emma Park)
Member id
UHC-67936-93
Confidence
0.99
Method
probabilistic
MBR-010195CLM-416134
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002702
Orphan claim re-pointed
Claims processor
CLM-425320 → UHC-95632-60 (Gerald Russell)
Member id
UHC-95632-60
Confidence
1
Method
probabilistic
MBR-000568CLM-425320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002703
Orphan claim re-pointed
Claims processor
CLM-414682 → UHC-78624-36 (Edward Chapman)
Member id
UHC-78624-36
Confidence
1
Method
probabilistic
MBR-025617CLM-414682
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002704
Orphan claim re-pointed
Claims processor
CLM-407664 → UHC-74632-47 (Christopher Bowman)
Member id
UHC-74632-47
Confidence
0.97
Method
deterministic
MBR-008362CLM-407664
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002705
Orphan claim re-pointed
Claims processor
CLM-430833 → UHC-52083-96 (Jesse Kim)
Member id
UHC-52083-96
Confidence
1
Method
probabilistic
MBR-004548CLM-430833
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002706
Orphan claim re-pointed
Claims processor
CLM-407087 → UHC-44422-88 (Ralph Daniels)
Member id
UHC-44422-88
Confidence
1
Method
probabilistic
MBR-000036CLM-407087
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002707
Orphan claim re-pointed
Claims processor
CLM-401259 → UHC-59285-16 (Nancy Delgado)
Member id
UHC-59285-16
Confidence
1
Method
probabilistic
MBR-003675CLM-401259
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002708
Orphan claim re-pointed
Claims processor
CLM-417345 → UHC-37551-83 (Ana Mason)
Member id
UHC-37551-83
Confidence
1
Method
probabilistic
MBR-020341CLM-417345
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002709
Orphan claim re-pointed
Claims processor
CLM-404809 → UHC-63795-99 (Michelle Fowler)
Member id
UHC-63795-99
Confidence
1
Method
probabilistic
MBR-028157CLM-404809
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002710
Orphan claim re-pointed
Claims processor
CLM-411743 → UHC-34549-49 (Albert Guzman)
Member id
UHC-34549-49
Confidence
0.94
Method
probabilistic
MBR-022651CLM-411743
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002711
Orphan claim re-pointed
Claims processor
CLM-419359 → UHC-61304-66 (Samantha Burns)
Member id
UHC-61304-66
Confidence
1
Method
probabilistic
MBR-028093CLM-419359
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002712
Orphan claim re-pointed
Claims processor
CLM-424166 → UHC-44839-36 (Mark Reyes)
Member id
UHC-44839-36
Confidence
1
Method
probabilistic
MBR-011567CLM-424166
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002713
Orphan claim re-pointed
Claims processor
CLM-426208 → UHC-77199-91 (Kyle Lawrence)
Member id
UHC-77199-91
Confidence
1
Method
probabilistic
MBR-006035CLM-426208
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002714
Orphan claim re-pointed
Claims processor
CLM-428450 → UHC-20288-13 (Heather Jackson)
Member id
UHC-20288-13
Confidence
0.97
Method
deterministic
MBR-018019CLM-428450
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002715
Orphan claim re-pointed
Claims processor
CLM-402226 → UHC-74636-77 (Alice Singh)
Member id
UHC-74636-77
Confidence
0.93
Method
probabilistic
MBR-008825CLM-402226
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002716
Orphan claim re-pointed
Claims processor
CLM-418765 → UHC-54913-54 (Tyler Vargas)
Member id
UHC-54913-54
Confidence
0.94
Method
probabilistic
MBR-013478CLM-418765
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002717
Orphan claim re-pointed
Claims processor
CLM-400599 → UHC-95609-38 (Kayla McDonald)
Member id
UHC-95609-38
Confidence
1
Method
probabilistic
MBR-037828CLM-400599
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002718
Orphan claim re-pointed
Claims processor
CLM-432085 → UHC-43805-72 (William Wells)
Member id
UHC-43805-72
Confidence
0.99
Method
probabilistic
MBR-015157CLM-432085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002719
Orphan claim re-pointed
Claims processor
CLM-429564 → UHC-71882-37 (Robert Robinson)
Member id
UHC-71882-37
Confidence
1
Method
probabilistic
MBR-000165CLM-429564
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002720
Orphan claim re-pointed
Claims processor
CLM-432075 → UHC-67683-28 (Emily Shaw)
Member id
UHC-67683-28
Confidence
1
Method
probabilistic
MBR-001486CLM-432075
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002721
Orphan claim re-pointed
Claims processor
CLM-426389 → UHC-69005-94 (Debra Sullivan)
Member id
UHC-69005-94
Confidence
1
Method
probabilistic
MBR-001663CLM-426389
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002722
Orphan claim re-pointed
Claims processor
CLM-427580 → UHC-53260-05 (Ralph Peterson)
Member id
UHC-53260-05
Confidence
1
Method
probabilistic
MBR-006611CLM-427580
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002723
Orphan claim re-pointed
Claims processor
CLM-410965 → UHC-16525-11 (Angela Vargas)
Member id
UHC-16525-11
Confidence
1
Method
probabilistic
MBR-004078CLM-410965
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002724
Orphan claim re-pointed
Claims processor
CLM-417073 → UHC-24476-29 (Hannah Williams)
Member id
UHC-24476-29
Confidence
1
Method
probabilistic
MBR-000004CLM-417073
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002725
Orphan claim re-pointed
Claims processor
CLM-427757 → UHC-02487-95 (Dennis Kelly)
Member id
UHC-02487-95
Confidence
1
Method
probabilistic
MBR-016016CLM-427757
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002726
Orphan claim re-pointed
Claims processor
CLM-400506 → UHC-03740-18 (William Ferguson)
Member id
UHC-03740-18
Confidence
1
Method
probabilistic
MBR-009687CLM-400506
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002727
Orphan claim re-pointed
Claims processor
CLM-406397 → UHC-04319-84 (Barbara Simpson)
Member id
UHC-04319-84
Confidence
1
Method
probabilistic
MBR-011042CLM-406397
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002728
Orphan claim re-pointed
Claims processor
CLM-424635 → UHC-40221-33 (Dylan Welch)
Member id
UHC-40221-33
Confidence
1
Method
probabilistic
MBR-025816CLM-424635
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002729
Orphan claim re-pointed
Claims processor
CLM-413132 → UHC-47460-74 (Steven Kelly)
Member id
UHC-47460-74
Confidence
0.97
Method
deterministic
MBR-019109CLM-413132
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002730
Orphan claim re-pointed
Claims processor
CLM-432080 → UHC-79111-93 (Scott Campbell)
Member id
UHC-79111-93
Confidence
1
Method
probabilistic
MBR-028283CLM-432080
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002731
Orphan claim re-pointed
Claims processor
CLM-416782 → UHC-87829-83 (Karen Meyer)
Member id
UHC-87829-83
Confidence
1
Method
probabilistic
MBR-007387CLM-416782
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002732
Orphan claim re-pointed
Claims processor
CLM-412804 → UHC-32846-70 (Jesse Stevens)
Member id
UHC-32846-70
Confidence
0.97
Method
deterministic
MBR-041042CLM-412804
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002733
Orphan claim re-pointed
Claims processor
CLM-423589 → UHC-44191-84 (Kevin Singh)
Member id
UHC-44191-84
Confidence
0.97
Method
deterministic
MBR-004924CLM-423589
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002734
Orphan claim re-pointed
Claims processor
CLM-417819 → UHC-14494-39 (Sharon Cox)
Member id
UHC-14494-39
Confidence
0.97
Method
deterministic
MBR-028773CLM-417819
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002735
Orphan claim re-pointed
Claims processor
CLM-404601 → UHC-72403-52 (Russell Elliott)
Member id
UHC-72403-52
Confidence
1
Method
probabilistic
MBR-019098CLM-404601
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002736
Orphan claim re-pointed
Claims processor
CLM-409624 → UHC-22515-20 (Bruce Adams)
Member id
UHC-22515-20
Confidence
0.97
Method
deterministic
MBR-034654CLM-409624
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002737
Orphan claim re-pointed
Claims processor
CLM-407609 → UHC-88336-76 (Richard Washington)
Member id
UHC-88336-76
Confidence
1
Method
probabilistic
MBR-034353CLM-407609
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002738
Orphan claim re-pointed
Claims processor
CLM-419247 → UHC-20089-46 (Sophia Bell)
Member id
UHC-20089-46
Confidence
0.93
Method
probabilistic
MBR-027431CLM-419247
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002739
Orphan claim re-pointed
Claims processor
CLM-417820 → UHC-02024-63 (Rachel Knight)
Member id
UHC-02024-63
Confidence
0.97
Method
deterministic
MBR-032025CLM-417820
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 28 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.