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-002740
Orphan claim re-pointed
Claims processor
CLM-411257 → UHC-34912-78 (Jessica Vargas)
Member id
UHC-34912-78
Confidence
1
Method
probabilistic
MBR-000636CLM-411257
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002741
Orphan claim re-pointed
Claims processor
CLM-418147 → UHC-72529-98 (Vincent Thomas)
Member id
UHC-72529-98
Confidence
1
Method
probabilistic
MBR-008558CLM-418147
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002742
Orphan claim re-pointed
Claims processor
CLM-412184 → UHC-00823-45 (Kathryn Hart)
Member id
UHC-00823-45
Confidence
1
Method
probabilistic
MBR-010033CLM-412184
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002743
Orphan claim re-pointed
Claims processor
CLM-417916 → UHC-78083-57 (Judith West)
Member id
UHC-78083-57
Confidence
0.86
Method
probabilistic
MBR-012031CLM-417916
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002744
Orphan claim re-pointed
Claims processor
CLM-405477 → UHC-12782-69 (Watson Steven)
Member id
UHC-12782-69
Confidence
1
Method
probabilistic
MBR-020361CLM-405477
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002745
Orphan claim re-pointed
Claims processor
CLM-400217 → UHC-17817-28 (Harold Pena)
Member id
UHC-17817-28
Confidence
1
Method
probabilistic
MBR-011646CLM-400217
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002746
Orphan claim re-pointed
Claims processor
CLM-410227 → UHC-56472-37 (Lori Coooper)
Member id
UHC-56472-37
Confidence
0.98
Method
probabilistic
MBR-027834CLM-410227
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002747
Orphan claim re-pointed
Claims processor
CLM-406085 → UHC-37995-02 (Santiago Phillips)
Member id
UHC-37995-02
Confidence
1
Method
probabilistic
MBR-031544CLM-406085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002748
Orphan claim re-pointed
Claims processor
CLM-409191 → UHC-85772-60 (Jerry Rojas)
Member id
UHC-85772-60
Confidence
1
Method
probabilistic
MBR-009572CLM-409191
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002749
Orphan claim re-pointed
Claims processor
CLM-418685 → UHC-97712-18 (Noah Franklin)
Member id
UHC-97712-18
Confidence
1
Method
probabilistic
MBR-001244CLM-418685
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002750
Orphan claim re-pointed
Claims processor
CLM-428646 → UHC-43545-99 (Madison Johnston)
Member id
UHC-43545-99
Confidence
1.00
Method
probabilistic
MBR-028144CLM-428646
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002751
Orphan claim re-pointed
Claims processor
CLM-405306 → UHC-89211-17 (Dnise Sandoval)
Member id
UHC-89211-17
Confidence
0.97
Method
deterministic
MBR-018465CLM-405306
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002752
Orphan claim re-pointed
Claims processor
CLM-417263 → UHC-30181-71 (Adam Dunn)
Member id
UHC-30181-71
Confidence
1
Method
probabilistic
MBR-018956CLM-417263
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002753
Orphan claim re-pointed
Claims processor
CLM-413608 → UHC-19719-99 (Lucia Castillo)
Member id
UHC-19719-99
Confidence
0.97
Method
deterministic
MBR-009790CLM-413608
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002754
Orphan claim re-pointed
Claims processor
CLM-432537 → UHC-00910-81 (Doris McDonald)
Member id
UHC-00910-81
Confidence
1
Method
probabilistic
MBR-002629CLM-432537
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002755
Orphan claim re-pointed
Claims processor
CLM-420757 → UHC-29811-40 (Ken Duncan)
Member id
UHC-29811-40
Confidence
0.94
Method
probabilistic
MBR-017051CLM-420757
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002756
Orphan claim re-pointed
Claims processor
CLM-401682 → UHC-35149-69 (Abigail Coleman)
Member id
UHC-35149-69
Confidence
1
Method
probabilistic
MBR-003873CLM-401682
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002757
Orphan claim re-pointed
Claims processor
CLM-414970 → UHC-58152-86 (Barbara Palmer)
Member id
UHC-58152-86
Confidence
0.97
Method
deterministic
MBR-024424CLM-414970
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002758
Orphan claim re-pointed
Claims processor
CLM-400353 → UHC-40216-61 (Elizabeth Elizabeth)
Member id
UHC-40216-61
Confidence
0.98
Method
probabilistic
MBR-034293CLM-400353
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002759
Orphan claim re-pointed
Claims processor
CLM-419161 → UHC-32991-98 (Benjamin Gomez)
Member id
UHC-32991-98
Confidence
0.99
Method
probabilistic
MBR-026623CLM-419161
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002760
Orphan claim re-pointed
Claims processor
CLM-425440 → UHC-25028-43 (Donald Lene)
Member id
UHC-25028-43
Confidence
0.97
Method
probabilistic
MBR-033980CLM-425440
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002761
Orphan claim re-pointed
Claims processor
CLM-429052 → UHC-36756-03 (William Hall)
Member id
UHC-36756-03
Confidence
1
Method
probabilistic
MBR-007217CLM-429052
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002762
Orphan claim re-pointed
Claims processor
CLM-408867 → UHC-03470-58 (George Wallace)
Member id
UHC-03470-58
Confidence
0.92
Method
probabilistic
MBR-001613CLM-408867
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002763
Orphan claim re-pointed
Claims processor
CLM-419274 → UHC-51195-87 (Kelly Espinoza)
Member id
UHC-51195-87
Confidence
1
Method
probabilistic
MBR-019030CLM-419274
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002764
Orphan claim re-pointed
Claims processor
CLM-428978 → UHC-20430-89 (Julia Ramos)
Member id
UHC-20430-89
Confidence
1
Method
probabilistic
MBR-034943CLM-428978
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002765
Orphan claim re-pointed
Claims processor
CLM-402952 → UHC-52045-15 (Linda Garrett)
Member id
UHC-52045-15
Confidence
0.97
Method
deterministic
MBR-001868CLM-402952
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002766
Orphan claim re-pointed
Claims processor
CLM-420603 → UHC-33706-77 (Bryan Ryan)
Member id
UHC-33706-77
Confidence
1
Method
probabilistic
MBR-018431CLM-420603
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002767
Orphan claim re-pointed
Claims processor
CLM-421601 → UHC-05399-64 (Shirley Gilbert)
Member id
UHC-05399-64
Confidence
1
Method
probabilistic
MBR-006765CLM-421601
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002768
Orphan claim re-pointed
Claims processor
CLM-407019 → UHC-48679-36 (David Henry)
Member id
UHC-48679-36
Confidence
1
Method
probabilistic
MBR-023674CLM-407019
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002769
Orphan claim re-pointed
Claims processor
CLM-425431 → UHC-14829-62 (Larry Mendoza)
Member id
UHC-14829-62
Confidence
1
Method
probabilistic
MBR-004711CLM-425431
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002770
Orphan claim re-pointed
Claims processor
CLM-421484 → UHC-06965-04 (Noah Torres)
Member id
UHC-06965-04
Confidence
0.97
Method
deterministic
MBR-035408CLM-421484
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002771
Orphan claim re-pointed
Claims processor
CLM-422783 → UHC-17335-35 (Eric Rojas)
Member id
UHC-17335-35
Confidence
0.97
Method
deterministic
MBR-025415CLM-422783
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002772
Orphan claim re-pointed
Claims processor
CLM-424102 → UHC-36356-27 (Edward George)
Member id
UHC-36356-27
Confidence
0.97
Method
deterministic
MBR-004829CLM-424102
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002773
Orphan claim re-pointed
Claims processor
CLM-415152 → UHC-65736-97 (Cynthia Hughes)
Member id
UHC-65736-97
Confidence
1.00
Method
probabilistic
MBR-007063CLM-415152
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002774
Orphan claim re-pointed
Claims processor
CLM-427615 → UHC-70116-01 (Matthew Walker)
Member id
UHC-70116-01
Confidence
1
Method
probabilistic
MBR-024996CLM-427615
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002775
Orphan claim re-pointed
Claims processor
CLM-427100 → UHC-63226-44 (Timothy Wang)
Member id
UHC-63226-44
Confidence
1
Method
probabilistic
MBR-024209CLM-427100
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002776
Orphan claim re-pointed
Claims processor
CLM-417083 → UHC-05458-06 (Theresa Sullivan)
Member id
UHC-05458-06
Confidence
0.97
Method
deterministic
MBR-027991CLM-417083
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002777
Orphan claim re-pointed
Claims processor
CLM-426786 → UHC-75200-93 (Angela Ellis)
Member id
UHC-75200-93
Confidence
1
Method
probabilistic
MBR-007350CLM-426786
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002778
Orphan claim re-pointed
Claims processor
CLM-407263 → UHC-05853-23 (Thomas Tran)
Member id
UHC-05853-23
Confidence
0.97
Method
deterministic
MBR-021053CLM-407263
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002779
Orphan claim re-pointed
Claims processor
CLM-426182 → UHC-01358-75 (Kevin Tucker)
Member id
UHC-01358-75
Confidence
0.98
Method
probabilistic
MBR-004967CLM-426182
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002780
Orphan claim re-pointed
Claims processor
CLM-432126 → UHC-30484-31 (Raymond Richardson)
Member id
UHC-30484-31
Confidence
0.97
Method
deterministic
MBR-003931CLM-432126
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002781
Orphan claim re-pointed
Claims processor
CLM-423972 → UHC-90465-53 (Isabella Edwards)
Member id
UHC-90465-53
Confidence
1
Method
probabilistic
MBR-021295CLM-423972
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002782
Orphan claim re-pointed
Claims processor
CLM-430210 → UHC-63930-87 (Alan Gilbert)
Member id
UHC-63930-87
Confidence
1
Method
probabilistic
MBR-013809CLM-430210
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002783
Orphan claim re-pointed
Claims processor
CLM-402562 → UHC-84832-60 (Melissa Black)
Member id
UHC-84832-60
Confidence
0.97
Method
deterministic
MBR-021820CLM-402562
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002784
Orphan claim re-pointed
Claims processor
CLM-428295 → UHC-94402-84 (Anna Obrien)
Member id
UHC-94402-84
Confidence
0.97
Method
deterministic
MBR-018108CLM-428295
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002785
Orphan claim re-pointed
Claims processor
CLM-429082 → UHC-44841-77 (Lawrence Andrews)
Member id
UHC-44841-77
Confidence
1
Method
probabilistic
MBR-016363CLM-429082
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002786
Orphan claim re-pointed
Claims processor
CLM-423108 → UHC-04176-72 (Raymond Collins)
Member id
UHC-04176-72
Confidence
1
Method
probabilistic
MBR-006062CLM-423108
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002787
Orphan claim re-pointed
Claims processor
CLM-405530 → UHC-66614-26 (Denise Dunn)
Member id
UHC-66614-26
Confidence
1
Method
probabilistic
MBR-009332CLM-405530
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002788
Orphan claim re-pointed
Claims processor
CLM-422681 → UHC-21693-90 (Dylan Grant)
Member id
UHC-21693-90
Confidence
1
Method
probabilistic
MBR-019294CLM-422681
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002789
Orphan claim re-pointed
Claims processor
CLM-407916 → UHC-74491-09 (Gabriel Castro)
Member id
UHC-74491-09
Confidence
0.99
Method
probabilistic
MBR-033358CLM-407916
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 29 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.