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-002790
Orphan claim re-pointed
Claims processor
CLM-404255 → UHC-47728-62 (Jordan Ross)
Member id
UHC-47728-62
Confidence
0.91
Method
probabilistic
MBR-039921CLM-404255
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002791
Orphan claim re-pointed
Claims processor
CLM-405930 → UHC-41376-70 (Michael Wells)
Member id
UHC-41376-70
Confidence
1
Method
probabilistic
MBR-012951CLM-405930
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002792
Orphan claim re-pointed
Claims processor
CLM-432598 → UHC-33766-76 (Joyce Collins)
Member id
UHC-33766-76
Confidence
1
Method
probabilistic
MBR-003912CLM-432598
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002793
Orphan claim re-pointed
Claims processor
CLM-407619 → UHC-68405-99 (Timothy Kim)
Member id
UHC-68405-99
Confidence
1
Method
probabilistic
MBR-036961CLM-407619
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002794
Orphan claim re-pointed
Claims processor
CLM-414103 → UHC-91321-72 (Amanda Shaw)
Member id
UHC-91321-72
Confidence
1
Method
probabilistic
MBR-000905CLM-414103
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002795
Orphan claim re-pointed
Claims processor
CLM-432154 → UHC-76846-41 (Kelly Gutierrez)
Member id
UHC-76846-41
Confidence
1
Method
probabilistic
MBR-018472CLM-432154
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002796
Orphan claim re-pointed
Claims processor
CLM-429911 → UHC-14773-40 (Angela Cooper)
Member id
UHC-14773-40
Confidence
1
Method
probabilistic
MBR-030772CLM-429911
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002797
Orphan claim re-pointed
Claims processor
CLM-411432 → UHC-06434-75 (Harold Nguyen)
Member id
UHC-06434-75
Confidence
1
Method
probabilistic
MBR-011118CLM-411432
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002798
Orphan claim re-pointed
Claims processor
CLM-426328 → UHC-26756-01 (Frank Fernandez)
Member id
UHC-26756-01
Confidence
1
Method
probabilistic
MBR-024771CLM-426328
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002799
Orphan claim re-pointed
Claims processor
CLM-422359 → UHC-07385-60 (Nancy Williamson)
Member id
UHC-07385-60
Confidence
1
Method
probabilistic
MBR-018321CLM-422359
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002800
Orphan claim re-pointed
Claims processor
CLM-426106 → UHC-27206-41 (Rachel Wagner)
Member id
UHC-27206-41
Confidence
1
Method
probabilistic
MBR-007541CLM-426106
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002801
Orphan claim re-pointed
Claims processor
CLM-410278 → UHC-87261-18 (Angela Foster)
Member id
UHC-87261-18
Confidence
1
Method
probabilistic
MBR-003791CLM-410278
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002802
Orphan claim re-pointed
Claims processor
CLM-413383 → UHC-39437-35 (Robert Jordan)
Member id
UHC-39437-35
Confidence
1
Method
probabilistic
MBR-017627CLM-413383
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002803
Orphan claim re-pointed
Claims processor
CLM-400157 → UHC-61957-49 (Mateo Lawson)
Member id
UHC-61957-49
Confidence
0.97
Method
deterministic
MBR-017254CLM-400157
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002804
Orphan claim re-pointed
Claims processor
CLM-430272 → UHC-76821-72 (Paul Lynch)
Member id
UHC-76821-72
Confidence
0.99
Method
probabilistic
MBR-014594CLM-430272
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002805
Orphan claim re-pointed
Claims processor
CLM-420539 → UHC-35602-95 (Frank Burton)
Member id
UHC-35602-95
Confidence
1
Method
probabilistic
MBR-025310CLM-420539
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002806
Orphan claim re-pointed
Claims processor
CLM-425656 → UHC-82804-57 (Jack Kennedy)
Member id
UHC-82804-57
Confidence
1
Method
probabilistic
MBR-023350CLM-425656
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002807
Orphan claim re-pointed
Claims processor
CLM-428598 → UHC-17486-80 (Donald Gomez)
Member id
UHC-17486-80
Confidence
1
Method
probabilistic
MBR-021769CLM-428598
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002808
Orphan claim re-pointed
Claims processor
CLM-414089 → UHC-63894-92 (Tyler Adams)
Member id
UHC-63894-92
Confidence
1
Method
probabilistic
MBR-009269CLM-414089
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002809
Orphan claim re-pointed
Claims processor
CLM-417892 → UHC-17587-12 (Justin Tran)
Member id
UHC-17587-12
Confidence
1
Method
probabilistic
MBR-013210CLM-417892
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002810
Orphan claim re-pointed
Claims processor
CLM-414592 → UHC-63679-21 (Kevin George)
Member id
UHC-63679-21
Confidence
0.97
Method
deterministic
MBR-007002CLM-414592
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002811
Orphan claim re-pointed
Claims processor
CLM-407453 → UHC-82007-66 (Jose Reyes)
Member id
UHC-82007-66
Confidence
1
Method
probabilistic
MBR-036095CLM-407453
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002812
Orphan claim re-pointed
Claims processor
CLM-403080 → UHC-50013-23 (Roy Howell)
Member id
UHC-50013-23
Confidence
1
Method
probabilistic
MBR-013990CLM-403080
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002813
Orphan claim re-pointed
Claims processor
CLM-418577 → UHC-44307-53 (Keith Hicks)
Member id
UHC-44307-53
Confidence
0.97
Method
deterministic
MBR-018493CLM-418577
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002814
Orphan claim re-pointed
Claims processor
CLM-422724 → UHC-08766-91 (Catherine Watkins)
Member id
UHC-08766-91
Confidence
1
Method
probabilistic
MBR-002653CLM-422724
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002815
Orphan claim re-pointed
Claims processor
CLM-406032 → UHC-80888-58 (Wei Jimenez)
Member id
UHC-80888-58
Confidence
1
Method
probabilistic
MBR-007476CLM-406032
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002816
Orphan claim re-pointed
Claims processor
CLM-404444 → UHC-76520-73 (Sandra Kim)
Member id
UHC-76520-73
Confidence
0.97
Method
deterministic
MBR-000585CLM-404444
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002817
Orphan claim re-pointed
Claims processor
CLM-412415 → UHC-21841-47 (Virginia Smith)
Member id
UHC-21841-47
Confidence
0.97
Method
deterministic
MBR-012954CLM-412415
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002818
Orphan claim re-pointed
Claims processor
CLM-432748 → UHC-29736-44 (Maria Fields)
Member id
UHC-29736-44
Confidence
1
Method
probabilistic
MBR-024990CLM-432748
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002819
Orphan claim re-pointed
Claims processor
CLM-412800 → UHC-28763-39 (Keith Burns)
Member id
UHC-28763-39
Confidence
1
Method
probabilistic
MBR-024962CLM-412800
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002820
Orphan claim re-pointed
Claims processor
CLM-414900 → UHC-31468-14 (Wayne Aguilar)
Member id
UHC-31468-14
Confidence
1
Method
probabilistic
MBR-004275CLM-414900
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002821
Orphan claim re-pointed
Claims processor
CLM-409736 → UHC-85355-99 (Christina Sullivan)
Member id
UHC-85355-99
Confidence
0.97
Method
deterministic
MBR-006887CLM-409736
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002822
Orphan claim re-pointed
Claims processor
CLM-414043 → UHC-40167-97 (Stephen Lawson)
Member id
UHC-40167-97
Confidence
1
Method
probabilistic
MBR-020384CLM-414043
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002823
Orphan claim re-pointed
Claims processor
CLM-413472 → UHC-80735-98 (Jonathan Dunn)
Member id
UHC-80735-98
Confidence
1
Method
probabilistic
MBR-002847CLM-413472
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002824
Orphan claim re-pointed
Claims processor
CLM-426571 → UHC-98914-41 (Terry Butler)
Member id
UHC-98914-41
Confidence
0.98
Method
probabilistic
MBR-009678CLM-426571
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002825
Orphan claim re-pointed
Claims processor
CLM-406429 → UHC-45542-39 (Ashley Mason)
Member id
UHC-45542-39
Confidence
1
Method
probabilistic
MBR-030976CLM-406429
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002826
Orphan claim re-pointed
Claims processor
CLM-420614 → UHC-70265-57 (Sandra Bell)
Member id
UHC-70265-57
Confidence
1
Method
probabilistic
MBR-015249CLM-420614
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002827
Orphan claim re-pointed
Claims processor
CLM-424600 → UHC-05637-01 (Philip Maldonado)
Member id
UHC-05637-01
Confidence
1
Method
probabilistic
MBR-006353CLM-424600
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002828
Orphan claim re-pointed
Claims processor
CLM-408373 → UHC-21873-56 (Carl Pierce)
Member id
UHC-21873-56
Confidence
1
Method
probabilistic
MBR-031934CLM-408373
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002829
Orphan claim re-pointed
Claims processor
CLM-413739 → UHC-51134-40 (Bryan Ferguson)
Member id
UHC-51134-40
Confidence
0.97
Method
deterministic
MBR-023502CLM-413739
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002830
Orphan claim re-pointed
Claims processor
CLM-411225 → UHC-63213-46 (Donald Russell)
Member id
UHC-63213-46
Confidence
1
Method
probabilistic
MBR-001037CLM-411225
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002831
Orphan claim re-pointed
Claims processor
CLM-403520 → UHC-44150-48 (Marcus Nichols)
Member id
UHC-44150-48
Confidence
1
Method
probabilistic
MBR-010433CLM-403520
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002832
Orphan claim re-pointed
Claims processor
CLM-410213 → UHC-39881-92 (Frances Diaz)
Member id
UHC-39881-92
Confidence
1
Method
probabilistic
MBR-035564CLM-410213
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002833
Orphan claim re-pointed
Claims processor
CLM-411292 → UHC-84090-92 (Juan Watkins)
Member id
UHC-84090-92
Confidence
1
Method
probabilistic
MBR-013943CLM-411292
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002834
Orphan claim re-pointed
Claims processor
CLM-419311 → UHC-46372-65 (Melissa Chavez)
Member id
UHC-46372-65
Confidence
1
Method
probabilistic
MBR-033289CLM-419311
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002835
Orphan claim re-pointed
Claims processor
CLM-402102 → UHC-73034-90 (Jordan Burton)
Member id
UHC-73034-90
Confidence
0.99
Method
probabilistic
MBR-002691CLM-402102
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002836
Orphan claim re-pointed
Claims processor
CLM-405236 → UHC-39201-16 (Robert Ross)
Member id
UHC-39201-16
Confidence
1
Method
probabilistic
MBR-008813CLM-405236
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002837
Orphan claim re-pointed
Claims processor
CLM-404765 → UHC-29124-63 (Julie Payne)
Member id
UHC-29124-63
Confidence
1
Method
probabilistic
MBR-003880CLM-404765
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002838
Orphan claim re-pointed
Claims processor
CLM-432351 → UHC-83195-17 (Julie Hall)
Member id
UHC-83195-17
Confidence
1
Method
probabilistic
MBR-005592CLM-432351
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002839
Orphan claim re-pointed
Claims processor
CLM-427014 → UHC-34653-59 (Madison Dean)
Member id
UHC-34653-59
Confidence
0.97
Method
deterministic
MBR-010923CLM-427014
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 30 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.