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-002840
Orphan claim re-pointed
Claims processor
CLM-404349 → UHC-59287-85 (Kathleen Cruz)
Member id
UHC-59287-85
Confidence
1
Method
probabilistic
MBR-013631CLM-404349
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002841
Orphan claim re-pointed
Claims processor
CLM-404626 → UHC-19839-19 (Evelyn Wilson)
Member id
UHC-19839-19
Confidence
0.97
Method
deterministic
MBR-022146CLM-404626
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002842
Orphan claim re-pointed
Claims processor
CLM-417455 → UHC-25086-59 (Pamela Chavez)
Member id
UHC-25086-59
Confidence
1
Method
probabilistic
MBR-027065CLM-417455
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002843
Orphan claim re-pointed
Claims processor
CLM-430619 → UHC-23080-10 (Timothy Simmons)
Member id
UHC-23080-10
Confidence
1
Method
probabilistic
MBR-015447CLM-430619
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002844
Orphan claim re-pointed
Claims processor
CLM-425736 → UHC-69450-62 (Sharon Stevens)
Member id
UHC-69450-62
Confidence
0.99
Method
probabilistic
MBR-018785CLM-425736
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002845
Orphan claim re-pointed
Claims processor
CLM-416855 → UHC-92808-15 (Jeffrey Mendoza)
Member id
UHC-92808-15
Confidence
1
Method
probabilistic
MBR-014882CLM-416855
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002846
Orphan claim re-pointed
Claims processor
CLM-427848 → UHC-64161-60 (Sean Mason)
Member id
UHC-64161-60
Confidence
1
Method
probabilistic
MBR-003438CLM-427848
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002847
Orphan claim re-pointed
Claims processor
CLM-423925 → UHC-34181-47 (Marcus Fuller)
Member id
UHC-34181-47
Confidence
1
Method
probabilistic
MBR-004491CLM-423925
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002848
Orphan claim re-pointed
Claims processor
CLM-423133 → UHC-34324-18 (Bruce Jackson)
Member id
UHC-34324-18
Confidence
0.99
Method
probabilistic
MBR-003566CLM-423133
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002849
Orphan claim re-pointed
Claims processor
CLM-432601 → UHC-61230-96 (Yuki Ross)
Member id
UHC-61230-96
Confidence
1
Method
probabilistic
MBR-024191CLM-432601
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002850
Orphan claim re-pointed
Claims processor
CLM-410656 → UHC-46520-48 (Amanda Foster)
Member id
UHC-46520-48
Confidence
1
Method
probabilistic
MBR-022314CLM-410656
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002851
Orphan claim re-pointed
Claims processor
CLM-401272 → UHC-76399-31 (Mason Porter)
Member id
UHC-76399-31
Confidence
1
Method
probabilistic
MBR-001447CLM-401272
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002852
Orphan claim re-pointed
Claims processor
CLM-423862 → UHC-97671-82 (Heather Fuller)
Member id
UHC-97671-82
Confidence
1
Method
probabilistic
MBR-002082CLM-423862
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002853
Orphan claim re-pointed
Claims processor
CLM-408804 → UHC-34202-75 (Mary Moreno)
Member id
UHC-34202-75
Confidence
0.98
Method
probabilistic
MBR-000091CLM-408804
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002854
Orphan claim re-pointed
Claims processor
CLM-423670 → UHC-06456-53 (Sharon Romero)
Member id
UHC-06456-53
Confidence
1
Method
probabilistic
MBR-013617CLM-423670
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002855
Orphan claim re-pointed
Claims processor
CLM-401972 → UHC-76890-92 (Walter Palmer)
Member id
UHC-76890-92
Confidence
1
Method
probabilistic
MBR-014740CLM-401972
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002856
Orphan claim re-pointed
Claims processor
CLM-401824 → UHC-49494-33 (Janet Johnson)
Member id
UHC-49494-33
Confidence
1
Method
probabilistic
MBR-006243CLM-401824
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002857
Orphan claim re-pointed
Claims processor
CLM-420693 → UHC-95700-66 (Juan Gonzales)
Member id
UHC-95700-66
Confidence
1
Method
probabilistic
MBR-014535CLM-420693
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002858
Orphan claim re-pointed
Claims processor
CLM-426991 → UHC-38108-73 (Martha Jenkins)
Member id
UHC-38108-73
Confidence
0.97
Method
deterministic
MBR-005073CLM-426991
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002859
Orphan claim re-pointed
Claims processor
CLM-400747 → UHC-89515-83 (Shirley Williamson)
Member id
UHC-89515-83
Confidence
1
Method
probabilistic
MBR-034444CLM-400747
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002860
Orphan claim re-pointed
Claims processor
CLM-407254 → UHC-52614-08 (Bobby Garrett)
Member id
UHC-52614-08
Confidence
1
Method
probabilistic
MBR-015790CLM-407254
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002861
Orphan claim re-pointed
Claims processor
CLM-412105 → UHC-97630-84 (Hannah Lawrence)
Member id
UHC-97630-84
Confidence
0.97
Method
deterministic
MBR-023142CLM-412105
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002862
Orphan claim re-pointed
Claims processor
CLM-413221 → UHC-82132-71 (Janice Weber)
Member id
UHC-82132-71
Confidence
1
Method
probabilistic
MBR-016220CLM-413221
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002863
Orphan claim re-pointed
Claims processor
CLM-417984 → UHC-74487-51 (Christine Delgado)
Member id
UHC-74487-51
Confidence
1
Method
probabilistic
MBR-004740CLM-417984
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002864
Orphan claim re-pointed
Claims processor
CLM-413927 → UHC-29180-53 (Sean Tucker)
Member id
UHC-29180-53
Confidence
1
Method
probabilistic
MBR-007943CLM-413927
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002865
Orphan claim re-pointed
Claims processor
CLM-429285 → UHC-12005-81 (Samantha Watkins)
Member id
UHC-12005-81
Confidence
0.97
Method
deterministic
MBR-024510CLM-429285
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002866
Orphan claim re-pointed
Claims processor
CLM-423502 → UHC-29410-17 (David Montgomery)
Member id
UHC-29410-17
Confidence
0.97
Method
deterministic
MBR-015463CLM-423502
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002867
Orphan claim re-pointed
Claims processor
CLM-423559 → UHC-87270-42 (David Brooks)
Member id
UHC-87270-42
Confidence
1
Method
probabilistic
MBR-029412CLM-423559
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002868
Orphan claim re-pointed
Claims processor
CLM-417483 → UHC-28858-52 (Amber Ortega)
Member id
UHC-28858-52
Confidence
1
Method
probabilistic
MBR-011475CLM-417483
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002869
Orphan claim re-pointed
Claims processor
CLM-400323 → UHC-70030-79 (Peter Garrett)
Member id
UHC-70030-79
Confidence
1
Method
probabilistic
MBR-007376CLM-400323
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002870
Orphan claim re-pointed
Claims processor
CLM-414431 → UHC-15556-78 (Justin Snyder)
Member id
UHC-15556-78
Confidence
1
Method
probabilistic
MBR-004064CLM-414431
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002871
Orphan claim re-pointed
Claims processor
CLM-424697 → UHC-50069-87 (Barbara Jackson)
Member id
UHC-50069-87
Confidence
1
Method
probabilistic
MBR-018611CLM-424697
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002872
Orphan claim re-pointed
Claims processor
CLM-425873 → UHC-61450-81 (Judy Rogers)
Member id
UHC-61450-81
Confidence
1
Method
probabilistic
MBR-023079CLM-425873
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002873
Orphan claim re-pointed
Claims processor
CLM-432264 → UHC-24573-21 (Bryan Vargas)
Member id
UHC-24573-21
Confidence
1
Method
probabilistic
MBR-004813CLM-432264
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002874
Orphan claim re-pointed
Claims processor
CLM-409287 → UHC-66382-01 (Juan Hoffman)
Member id
UHC-66382-01
Confidence
1
Method
probabilistic
MBR-019962CLM-409287
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002875
Orphan claim re-pointed
Claims processor
CLM-410200 → UHC-71115-60 (Danielle Bell)
Member id
UHC-71115-60
Confidence
1
Method
probabilistic
MBR-014300CLM-410200
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002876
Orphan claim re-pointed
Claims processor
CLM-425510 → UHC-17694-70 (Aaron Watkins)
Member id
UHC-17694-70
Confidence
0.93
Method
probabilistic
MBR-010590CLM-425510
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002877
Orphan claim re-pointed
Claims processor
CLM-413865 → UHC-04768-23 (Omar Mason)
Member id
UHC-04768-23
Confidence
1
Method
probabilistic
MBR-011526CLM-413865
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002878
Orphan claim re-pointed
Claims processor
CLM-418010 → UHC-91781-59 (Carol Ward)
Member id
UHC-91781-59
Confidence
0.98
Method
probabilistic
MBR-001207CLM-418010
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002879
Orphan claim re-pointed
Claims processor
CLM-420224 → UHC-68548-08 (Diego Lawrence)
Member id
UHC-68548-08
Confidence
1
Method
probabilistic
MBR-011917CLM-420224
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002880
Orphan claim re-pointed
Claims processor
CLM-417497 → UHC-30693-81 (Tylr Perry)
Member id
UHC-30693-81
Confidence
0.92
Method
probabilistic
MBR-008738CLM-417497
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002881
Orphan claim re-pointed
Claims processor
CLM-411769 → UHC-90090-71 (Alice Price)
Member id
UHC-90090-71
Confidence
1
Method
probabilistic
MBR-007903CLM-411769
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002882
Orphan claim re-pointed
Claims processor
CLM-407344 → UHC-64300-08 (Douglas James)
Member id
UHC-64300-08
Confidence
1
Method
probabilistic
MBR-006364CLM-407344
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002883
Orphan claim re-pointed
Claims processor
CLM-425804 → UHC-42279-63 (Stephanie Chapman)
Member id
UHC-42279-63
Confidence
1
Method
probabilistic
MBR-019964CLM-425804
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002884
Orphan claim re-pointed
Claims processor
CLM-402028 → UHC-96272-72 (Richard Wright)
Member id
UHC-96272-72
Confidence
1
Method
probabilistic
MBR-004173CLM-402028
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002885
Orphan claim re-pointed
Claims processor
CLM-425340 → UHC-73038-56 (Thomas Gonzalez)
Member id
UHC-73038-56
Confidence
1
Method
probabilistic
MBR-002891CLM-425340
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002886
Orphan claim re-pointed
Claims processor
CLM-414496 → UHC-95172-81 (Aisha Wright)
Member id
UHC-95172-81
Confidence
0.97
Method
deterministic
MBR-012472CLM-414496
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002887
Orphan claim re-pointed
Claims processor
CLM-427623 → UHC-32742-91 (Amber Lee)
Member id
UHC-32742-91
Confidence
1
Method
probabilistic
MBR-000268CLM-427623
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002888
Orphan claim re-pointed
Claims processor
CLM-409567 → UHC-96771-59 (Debra Mitchell)
Member id
UHC-96771-59
Confidence
1
Method
probabilistic
MBR-013879CLM-409567
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002889
Orphan claim re-pointed
Claims processor
CLM-415385 → UHC-01909-90 (Sara Welch)
Member id
UHC-01909-90
Confidence
1
Method
probabilistic
MBR-035026CLM-415385
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 31 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.