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-002890
Orphan claim re-pointed
Claims processor
CLM-401249 → UHC-58390-13 (Lisa Hawkins)
Member id
UHC-58390-13
Confidence
0.97
Method
deterministic
MBR-028273CLM-401249
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002891
Orphan claim re-pointed
Claims processor
CLM-421971 → UHC-89812-55 (Jonathan Bowman)
Member id
UHC-89812-55
Confidence
0.97
Method
deterministic
MBR-006544CLM-421971
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002892
Orphan claim re-pointed
Claims processor
CLM-414452 → UHC-13952-38 (Yuki Wood)
Member id
UHC-13952-38
Confidence
1
Method
probabilistic
MBR-011081CLM-414452
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002893
Orphan claim re-pointed
Claims processor
CLM-430943 → UHC-64949-34 (Michelle Bowman)
Member id
UHC-64949-34
Confidence
1
Method
probabilistic
MBR-013784CLM-430943
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002894
Orphan claim re-pointed
Claims processor
CLM-427160 → UHC-37768-97 (Susan Owens)
Member id
UHC-37768-97
Confidence
0.97
Method
deterministic
MBR-020974CLM-427160
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002895
Orphan claim re-pointed
Claims processor
CLM-401794 → UHC-29142-83 (Grace James)
Member id
UHC-29142-83
Confidence
1
Method
probabilistic
MBR-014730CLM-401794
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002896
Orphan claim re-pointed
Claims processor
CLM-407517 → UHC-97544-20 (Lawrence Maldonado)
Member id
UHC-97544-20
Confidence
1
Method
probabilistic
MBR-000899CLM-407517
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002897
Orphan claim re-pointed
Claims processor
CLM-412349 → UHC-13186-78 (Valentina Daniels)
Member id
UHC-13186-78
Confidence
0.97
Method
deterministic
MBR-003344CLM-412349
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002898
Orphan claim re-pointed
Claims processor
CLM-412414 → UHC-54412-91 (Harold Smith)
Member id
UHC-54412-91
Confidence
1
Method
probabilistic
MBR-022789CLM-412414
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002899
Orphan claim re-pointed
Claims processor
CLM-432190 → UHC-18952-16 (Doris Obrien)
Member id
UHC-18952-16
Confidence
0.93
Method
probabilistic
MBR-018628CLM-432190
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002900
Orphan claim re-pointed
Claims processor
CLM-421190 → UHC-89616-14 (Brian Fuller)
Member id
UHC-89616-14
Confidence
0.93
Method
probabilistic
MBR-010687CLM-421190
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002901
Orphan claim re-pointed
Claims processor
CLM-426719 → UHC-58954-01 (Barbara Hicks)
Member id
UHC-58954-01
Confidence
1
Method
probabilistic
MBR-032711CLM-426719
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002902
Orphan claim re-pointed
Claims processor
CLM-411097 → UHC-90440-20 (Roger Robertson)
Member id
UHC-90440-20
Confidence
1
Method
probabilistic
MBR-017483CLM-411097
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002903
Orphan claim re-pointed
Claims processor
CLM-404163 → UHC-97762-04 (Emily Rojas)
Member id
UHC-97762-04
Confidence
0.97
Method
deterministic
MBR-013577CLM-404163
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002904
Orphan claim re-pointed
Claims processor
CLM-417095 → UHC-61639-29 (Ashley Olson)
Member id
UHC-61639-29
Confidence
0.97
Method
deterministic
MBR-036818CLM-417095
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002905
Orphan claim re-pointed
Claims processor
CLM-402547 → UHC-75180-73 (Katherine Martin)
Member id
UHC-75180-73
Confidence
0.97
Method
deterministic
MBR-018191CLM-402547
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002906
Orphan claim re-pointed
Claims processor
CLM-403195 → UHC-89275-42 (Dennis Hunt)
Member id
UHC-89275-42
Confidence
1
Method
probabilistic
MBR-033966CLM-403195
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002907
Orphan claim re-pointed
Claims processor
CLM-405747 → UHC-27611-32 (Virginia Grant)
Member id
UHC-27611-32
Confidence
1
Method
probabilistic
MBR-035415CLM-405747
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002908
Orphan claim re-pointed
Claims processor
CLM-429405 → UHC-79908-24 (Edward Edwards)
Member id
UHC-79908-24
Confidence
1
Method
probabilistic
MBR-025267CLM-429405
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002909
Orphan claim re-pointed
Claims processor
CLM-427849 → UHC-64161-60 (Sean Mason)
Member id
UHC-64161-60
Confidence
1
Method
probabilistic
MBR-003438CLM-427849
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002910
Orphan claim re-pointed
Claims processor
CLM-423049 → UHC-50559-22 (Alan Adams)
Member id
UHC-50559-22
Confidence
1
Method
probabilistic
MBR-022219CLM-423049
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002911
Orphan claim re-pointed
Claims processor
CLM-408620 → UHC-33957-43 (Kyle Vega)
Member id
UHC-33957-43
Confidence
1
Method
probabilistic
MBR-011634CLM-408620
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002912
Orphan claim re-pointed
Claims processor
CLM-427924 → UHC-21648-41 (Marcus Clark)
Member id
UHC-21648-41
Confidence
0.99
Method
probabilistic
MBR-010772CLM-427924
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002913
Orphan claim re-pointed
Claims processor
CLM-429845 → UHC-24431-19 (Diane Howell)
Member id
UHC-24431-19
Confidence
0.98
Method
probabilistic
MBR-043671CLM-429845
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002914
Orphan claim re-pointed
Claims processor
CLM-418916 → UHC-04083-81 (Natalie Yang)
Member id
UHC-04083-81
Confidence
1
Method
probabilistic
MBR-028100CLM-418916
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002915
Orphan claim re-pointed
Claims processor
CLM-402012 → UHC-30565-43 (Natalie Morgan)
Member id
UHC-30565-43
Confidence
1
Method
probabilistic
MBR-017156CLM-402012
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002916
Orphan claim re-pointed
Claims processor
CLM-413846 → UHC-02340-97 (Mei Lee)
Member id
UHC-02340-97
Confidence
1
Method
probabilistic
MBR-010235CLM-413846
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002917
Orphan claim re-pointed
Claims processor
CLM-400943 → UHC-76429-95 (Amber Walker)
Member id
UHC-76429-95
Confidence
1
Method
probabilistic
MBR-038473CLM-400943
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002918
Orphan claim re-pointed
Claims processor
CLM-412343 → UHC-19218-47 (Katherine Carter)
Member id
UHC-19218-47
Confidence
0.97
Method
deterministic
MBR-011815CLM-412343
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002919
Orphan claim re-pointed
Claims processor
CLM-413593 → UHC-13835-02 (Mark Arnold)
Member id
UHC-13835-02
Confidence
0.93
Method
probabilistic
MBR-034505CLM-413593
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002920
Orphan claim re-pointed
Claims processor
CLM-422019 → UHC-66524-42 (Cynthia Kelley)
Member id
UHC-66524-42
Confidence
0.94
Method
probabilistic
MBR-018413CLM-422019
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002921
Orphan claim re-pointed
Claims processor
CLM-425923 → UHC-94421-04 (Megan Allen)
Member id
UHC-94421-04
Confidence
1
Method
probabilistic
MBR-004533CLM-425923
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002922
Orphan claim re-pointed
Claims processor
CLM-421606 → UHC-29310-40 (Joe Lucas)
Member id
UHC-29310-40
Confidence
0.97
Method
deterministic
MBR-004544CLM-421606
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002923
Orphan claim re-pointed
Claims processor
CLM-401100 → UHC-51567-53 (Martha Padilla)
Member id
UHC-51567-53
Confidence
1
Method
probabilistic
MBR-003529CLM-401100
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002924
Orphan claim re-pointed
Claims processor
CLM-417977 → UHC-48459-62 (Hiroshi Park)
Member id
UHC-48459-62
Confidence
0.98
Method
probabilistic
MBR-005338CLM-417977
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002925
Orphan claim re-pointed
Claims processor
CLM-426577 → UHC-28952-82 (Ralph Kelley)
Member id
UHC-28952-82
Confidence
0.97
Method
deterministic
MBR-009663CLM-426577
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002926
Orphan claim re-pointed
Claims processor
CLM-421547 → UHC-89061-19 (Nathan Martinez)
Member id
UHC-89061-19
Confidence
1
Method
probabilistic
MBR-009420CLM-421547
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002927
Orphan claim re-pointed
Claims processor
CLM-416144 → UHC-00245-28 (Bryan Evans)
Member id
UHC-00245-28
Confidence
1
Method
probabilistic
MBR-029400CLM-416144
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002928
Orphan claim re-pointed
Claims processor
CLM-405290 → UHC-97566-56 (Catherine Myers)
Member id
UHC-97566-56
Confidence
0.99
Method
probabilistic
MBR-008124CLM-405290
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002929
Orphan claim re-pointed
Claims processor
CLM-416559 → UHC-69037-54 (Jack Bowman)
Member id
UHC-69037-54
Confidence
0.97
Method
deterministic
MBR-021077CLM-416559
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002930
Orphan claim re-pointed
Claims processor
CLM-428512 → UHC-54516-18 (Hannah Nelson)
Member id
UHC-54516-18
Confidence
1
Method
probabilistic
MBR-002099CLM-428512
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002931
Orphan claim re-pointed
Claims processor
CLM-406666 → UHC-90741-18 (Randy Lawrence)
Member id
UHC-90741-18
Confidence
1
Method
probabilistic
MBR-020995CLM-406666
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002932
Orphan claim re-pointed
Claims processor
CLM-407292 → UHC-65197-96 (Joyce Thompson)
Member id
UHC-65197-96
Confidence
0.93
Method
probabilistic
MBR-042049CLM-407292
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002933
Orphan claim re-pointed
Claims processor
CLM-427424 → UHC-83773-63 (Eric Russell)
Member id
UHC-83773-63
Confidence
1
Method
probabilistic
MBR-034445CLM-427424
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002934
Orphan claim re-pointed
Claims processor
CLM-421119 → UHC-85610-69 (Evelyn Maldonado)
Member id
UHC-85610-69
Confidence
1
Method
probabilistic
MBR-021644CLM-421119
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002935
Orphan claim re-pointed
Claims processor
CLM-419744 → UHC-31513-50 (Sophia Myers)
Member id
UHC-31513-50
Confidence
1
Method
probabilistic
MBR-022127CLM-419744
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002936
Orphan claim re-pointed
Claims processor
CLM-419553 → UHC-28348-73 (Gerald Fisher)
Member id
UHC-28348-73
Confidence
0.93
Method
probabilistic
MBR-039258CLM-419553
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002937
Orphan claim re-pointed
Claims processor
CLM-423377 → UHC-34873-65 (Jacob Cruz)
Member id
UHC-34873-65
Confidence
1
Method
probabilistic
MBR-019783CLM-423377
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002938
Orphan claim re-pointed
Claims processor
CLM-432355 → UHC-34803-46 (Mariana Morrison)
Member id
UHC-34803-46
Confidence
0.97
Method
deterministic
MBR-016992CLM-432355
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002939
Orphan claim re-pointed
Claims processor
CLM-417437 → UHC-92117-15 (Angela Sullivan)
Member id
UHC-92117-15
Confidence
1
Method
probabilistic
MBR-005196CLM-417437
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 32 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.