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-002940
Orphan claim re-pointed
Claims processor
CLM-411495 → UHC-15071-61 (Edward Ward)
Member id
UHC-15071-61
Confidence
0.99
Method
probabilistic
MBR-006040CLM-411495
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002941
Orphan claim re-pointed
Claims processor
CLM-427748 → UHC-55520-85 (Mark Valdez)
Member id
UHC-55520-85
Confidence
1
Method
probabilistic
MBR-011706CLM-427748
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002942
Orphan claim re-pointed
Claims processor
CLM-417547 → UHC-94639-58 (Cynthia Flores)
Member id
UHC-94639-58
Confidence
0.97
Method
deterministic
MBR-041462CLM-417547
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002943
Orphan claim re-pointed
Claims processor
CLM-417433 → UHC-20657-68 (Vicky Hamilton)
Member id
UHC-20657-68
Confidence
0.99
Method
probabilistic
MBR-002760CLM-417433
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002944
Orphan claim re-pointed
Claims processor
CLM-406210 → UHC-00624-02 (Kathryn Ramirez)
Member id
UHC-00624-02
Confidence
1
Method
probabilistic
MBR-025889CLM-406210
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002945
Orphan claim re-pointed
Claims processor
CLM-407950 → UHC-49719-35 (Juan Weaver)
Member id
UHC-49719-35
Confidence
1
Method
probabilistic
MBR-029456CLM-407950
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002946
Orphan claim re-pointed
Claims processor
CLM-407389 → UHC-64364-04 (Barb Schultz)
Member id
UHC-64364-04
Confidence
1
Method
probabilistic
MBR-006946CLM-407389
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002947
Orphan claim re-pointed
Claims processor
CLM-410179 → UHC-54232-44 (Brian Richardson)
Member id
UHC-54232-44
Confidence
1
Method
probabilistic
MBR-036933CLM-410179
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002948
Orphan claim re-pointed
Claims processor
CLM-411071 → UHC-35219-28 (Elizabeth Tucker)
Member id
UHC-35219-28
Confidence
0.97
Method
deterministic
MBR-029921CLM-411071
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002949
Orphan claim re-pointed
Claims processor
CLM-400832 → UHC-00120-23 (Hannah Burke)
Member id
UHC-00120-23
Confidence
1
Method
probabilistic
MBR-015128CLM-400832
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002950
Orphan claim re-pointed
Claims processor
CLM-426232 → UHC-68851-64 (Russell Holmes)
Member id
UHC-68851-64
Confidence
1
Method
probabilistic
MBR-012692CLM-426232
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002951
Orphan claim re-pointed
Claims processor
CLM-425972 → UHC-96613-08 (Natalie Johnston)
Member id
UHC-96613-08
Confidence
1
Method
probabilistic
MBR-015614CLM-425972
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002952
Orphan claim re-pointed
Claims processor
CLM-407714 → UHC-43246-58 (Amy Elliott)
Member id
UHC-43246-58
Confidence
1
Method
probabilistic
MBR-019067CLM-407714
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002953
Orphan claim re-pointed
Claims processor
CLM-416652 → UHC-53251-10 (Lori Gray)
Member id
UHC-53251-10
Confidence
0.97
Method
deterministic
MBR-028303CLM-416652
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002954
Orphan claim re-pointed
Claims processor
CLM-423809 → UHC-94219-79 (Natalie Crawford)
Member id
UHC-94219-79
Confidence
1
Method
probabilistic
MBR-023239CLM-423809
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002955
Orphan claim re-pointed
Claims processor
CLM-429302 → UHC-72399-15 (Kimberly Boyd)
Member id
UHC-72399-15
Confidence
1
Method
probabilistic
MBR-003776CLM-429302
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002956
Orphan claim re-pointed
Claims processor
CLM-408653 → UHC-87938-64 (Katherine Williamson)
Member id
UHC-87938-64
Confidence
1
Method
probabilistic
MBR-016128CLM-408653
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002957
Orphan claim re-pointed
Claims processor
CLM-402947 → UHC-97085-20 (Chistine Weaver)
Member id
UHC-97085-20
Confidence
0.97
Method
deterministic
MBR-014957CLM-402947
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002958
Orphan claim re-pointed
Claims processor
CLM-431015 → UHC-49258-37 (Chritsian Daniels)
Member id
UHC-49258-37
Confidence
1.00
Method
probabilistic
MBR-019293CLM-431015
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002959
Orphan claim re-pointed
Claims processor
CLM-423800 → UHC-40176-31 (Isabella Allen)
Member id
UHC-40176-31
Confidence
1
Method
probabilistic
MBR-022874CLM-423800
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002960
Orphan claim re-pointed
Claims processor
CLM-401290 → UHC-91005-74 (Nancy George)
Member id
UHC-91005-74
Confidence
0.99
Method
probabilistic
MBR-012862CLM-401290
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002961
Orphan claim re-pointed
Claims processor
CLM-404991 → UHC-58921-61 (Samuel Cruz)
Member id
UHC-58921-61
Confidence
0.96
Method
probabilistic
MBR-019509CLM-404991
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002962
Orphan claim re-pointed
Claims processor
CLM-412854 → UHC-22603-96 (Aisha McCoy)
Member id
UHC-22603-96
Confidence
0.97
Method
deterministic
MBR-024470CLM-412854
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002963
Orphan claim re-pointed
Claims processor
CLM-409422 → UHC-40678-60 (Jesse Hernandez)
Member id
UHC-40678-60
Confidence
1
Method
probabilistic
MBR-023867CLM-409422
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002964
Orphan claim re-pointed
Claims processor
CLM-412159 → UHC-00900-40 (Benjamin Rice)
Member id
UHC-00900-40
Confidence
0.94
Method
probabilistic
MBR-008390CLM-412159
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002965
Orphan claim re-pointed
Claims processor
CLM-415292 → UHC-21639-91 (Kathryn Contreras)
Member id
UHC-21639-91
Confidence
1
Method
probabilistic
MBR-008466CLM-415292
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002966
Orphan claim re-pointed
Claims processor
CLM-402890 → UHC-70840-06 (Grace Hawkins)
Member id
UHC-70840-06
Confidence
0.93
Method
probabilistic
MBR-016353CLM-402890
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002967
Orphan claim re-pointed
Claims processor
CLM-420792 → UHC-27291-77 (Diane Lewis)
Member id
UHC-27291-77
Confidence
1
Method
probabilistic
MBR-034970CLM-420792
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002968
Orphan claim re-pointed
Claims processor
CLM-423030 → UHC-06344-17 (Diana Bradley)
Member id
UHC-06344-17
Confidence
0.97
Method
deterministic
MBR-003450CLM-423030
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002969
Orphan claim re-pointed
Claims processor
CLM-410615 → UHC-86536-44 (Bobby Stephens)
Member id
UHC-86536-44
Confidence
1
Method
probabilistic
MBR-021500CLM-410615
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002970
Orphan claim re-pointed
Claims processor
CLM-426949 → UHC-06715-98 (Karen Powell)
Member id
UHC-06715-98
Confidence
1
Method
probabilistic
MBR-006911CLM-426949
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002971
Orphan claim re-pointed
Claims processor
CLM-429162 → UHC-10977-25 (Evelyn Grant)
Member id
UHC-10977-25
Confidence
0.99
Method
probabilistic
MBR-018177CLM-429162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002972
Orphan claim re-pointed
Claims processor
CLM-400421 → UHC-99110-39 (Sophia Evans)
Member id
UHC-99110-39
Confidence
0.97
Method
deterministic
MBR-042873CLM-400421
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002973
Orphan claim re-pointed
Claims processor
CLM-412542 → UHC-90874-75 (Debra Powell)
Member id
UHC-90874-75
Confidence
1
Method
probabilistic
MBR-019608CLM-412542
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002974
Orphan claim re-pointed
Claims processor
CLM-431032 → UHC-29407-99 (Lauren Snyder)
Member id
UHC-29407-99
Confidence
1
Method
probabilistic
MBR-018943CLM-431032
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002975
Orphan claim re-pointed
Claims processor
CLM-403533 → UHC-45932-54 (Mateo Kim)
Member id
UHC-45932-54
Confidence
1
Method
probabilistic
MBR-004779CLM-403533
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002976
Orphan claim re-pointed
Claims processor
CLM-414180 → UHC-51915-20 (Dorothy Boyd)
Member id
UHC-51915-20
Confidence
1
Method
probabilistic
MBR-026631CLM-414180
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002977
Orphan claim re-pointed
Claims processor
CLM-427759 → UHC-39408-66 (Raymond Black)
Member id
UHC-39408-66
Confidence
0.97
Method
deterministic
MBR-008823CLM-427759
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002978
Orphan claim re-pointed
Claims processor
CLM-415594 → UHC-51922-20 (Justin Alexander)
Member id
UHC-51922-20
Confidence
0.90
Method
probabilistic
MBR-028266CLM-415594
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002979
Orphan claim re-pointed
Claims processor
CLM-402901 → UHC-24458-91 (Sarah Green)
Member id
UHC-24458-91
Confidence
1
Method
probabilistic
MBR-003772CLM-402901
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002980
Orphan claim re-pointed
Claims processor
CLM-423654 → UHC-98958-75 (Jonathan Castillo)
Member id
UHC-98958-75
Confidence
1
Method
probabilistic
MBR-005391CLM-423654
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002981
Orphan claim re-pointed
Claims processor
CLM-411382 → UHC-22701-62 (Brandon Vazquez)
Member id
UHC-22701-62
Confidence
0.97
Method
deterministic
MBR-029477CLM-411382
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002982
Orphan claim re-pointed
Claims processor
CLM-409127 → UHC-97744-57 (Robert Pierce)
Member id
UHC-97744-57
Confidence
1
Method
probabilistic
MBR-004908CLM-409127
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002983
Orphan claim re-pointed
Claims processor
CLM-430295 → UHC-73490-52 (Helen Ellis)
Member id
UHC-73490-52
Confidence
0.97
Method
deterministic
MBR-016740CLM-430295
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002984
Orphan claim re-pointed
Claims processor
CLM-428308 → UHC-63351-43 (Jerry Perkins)
Member id
UHC-63351-43
Confidence
0.99
Method
probabilistic
MBR-007345CLM-428308
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002985
Orphan claim re-pointed
Claims processor
CLM-429796 → UHC-88610-44 (Sandra Hart)
Member id
UHC-88610-44
Confidence
1
Method
probabilistic
MBR-004045CLM-429796
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002986
Orphan claim re-pointed
Claims processor
CLM-403194 → UHC-89275-42 (Dennis Hunt)
Member id
UHC-89275-42
Confidence
1
Method
probabilistic
MBR-033966CLM-403194
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002987
Orphan claim re-pointed
Claims processor
CLM-420031 → UHC-84313-87 (Walter Vazquez)
Member id
UHC-84313-87
Confidence
1
Method
probabilistic
MBR-017241CLM-420031
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002988
Orphan claim re-pointed
Claims processor
CLM-417297 → UHC-16649-11 (Lawrence Chapman)
Member id
UHC-16649-11
Confidence
1
Method
probabilistic
MBR-016274CLM-417297
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002989
Orphan claim re-pointed
Claims processor
CLM-402210 → UHC-99178-38 (Alexis Shaw)
Member id
UHC-99178-38
Confidence
1
Method
probabilistic
MBR-015430CLM-402210
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 33 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.