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-002990
Orphan claim re-pointed
Claims processor
CLM-406552 → UHC-60822-04 (Martha Stone)
Member id
UHC-60822-04
Confidence
1
Method
probabilistic
MBR-025833CLM-406552
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002991
Orphan claim re-pointed
Claims processor
CLM-411223 → UHC-63213-46 (Donald Russell)
Member id
UHC-63213-46
Confidence
1
Method
probabilistic
MBR-001037CLM-411223
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002992
Orphan claim re-pointed
Claims processor
CLM-407649 → UHC-48905-18 (Austin Stone)
Member id
UHC-48905-18
Confidence
1
Method
probabilistic
MBR-014649CLM-407649
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002993
Orphan claim re-pointed
Claims processor
CLM-426806 → UHC-41493-30 (Jessica Williamson)
Member id
UHC-41493-30
Confidence
1
Method
probabilistic
MBR-006182CLM-426806
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002994
Orphan claim re-pointed
Claims processor
CLM-402153 → UHC-80131-43 (Mary Hansen)
Member id
UHC-80131-43
Confidence
1
Method
probabilistic
MBR-001996CLM-402153
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002995
Orphan claim re-pointed
Claims processor
CLM-408711 → UHC-66102-15 (Virginia Le)
Member id
UHC-66102-15
Confidence
1
Method
probabilistic
MBR-015917CLM-408711
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002996
Orphan claim re-pointed
Claims processor
CLM-429981 → UHC-32999-29 (Susan Williamson)
Member id
UHC-32999-29
Confidence
1
Method
probabilistic
MBR-037732CLM-429981
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002997
Orphan claim re-pointed
Claims processor
CLM-417611 → UHC-58714-51 (Mei Flores)
Member id
UHC-58714-51
Confidence
1
Method
probabilistic
MBR-039573CLM-417611
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002998
Orphan claim re-pointed
Claims processor
CLM-421681 → UHC-35330-66 (Abigail Torres)
Member id
UHC-35330-66
Confidence
0.97
Method
deterministic
MBR-017883CLM-421681
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002999
Orphan claim re-pointed
Claims processor
CLM-421831 → UHC-14190-34 (Carl Santos)
Member id
UHC-14190-34
Confidence
1
Method
probabilistic
MBR-015494CLM-421831
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003000
Orphan claim re-pointed
Claims processor
CLM-422619 → UHC-50635-73 (Danielle Lee)
Member id
UHC-50635-73
Confidence
1
Method
probabilistic
MBR-028626CLM-422619
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003001
Orphan claim re-pointed
Claims processor
CLM-415428 → UHC-21356-89 (Cynthia Alvarez)
Member id
UHC-21356-89
Confidence
1
Method
probabilistic
MBR-024553CLM-415428
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003002
Orphan claim re-pointed
Claims processor
CLM-426075 → UHC-20813-41 (Dorothy Peterson)
Member id
UHC-20813-41
Confidence
0.97
Method
deterministic
MBR-019987CLM-426075
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003003
Orphan claim re-pointed
Claims processor
CLM-414984 → UHC-76613-51 (Judith Romero)
Member id
UHC-76613-51
Confidence
1
Method
probabilistic
MBR-002088CLM-414984
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003004
Orphan claim re-pointed
Claims processor
CLM-428404 → UHC-83800-79 (Julie Evans)
Member id
UHC-83800-79
Confidence
1
Method
probabilistic
MBR-020970CLM-428404
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003005
Orphan claim re-pointed
Claims processor
CLM-430383 → UHC-80730-37 (Karen Mitchell)
Member id
UHC-80730-37
Confidence
1
Method
probabilistic
MBR-003200CLM-430383
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003006
Orphan claim re-pointed
Claims processor
CLM-425854 → UHC-91907-85 (Jose Barnes)
Member id
UHC-91907-85
Confidence
1
Method
probabilistic
MBR-020660CLM-425854
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003007
Orphan claim re-pointed
Claims processor
CLM-413855 → UHC-26778-24 (Sandra Cruz)
Member id
UHC-26778-24
Confidence
0.99
Method
probabilistic
MBR-027433CLM-413855
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003008
Orphan claim re-pointed
Claims processor
CLM-428318 → UHC-40643-26 (Alice Collins)
Member id
UHC-40643-26
Confidence
1
Method
probabilistic
MBR-013775CLM-428318
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003009
Orphan claim re-pointed
Claims processor
CLM-422454 → UHC-60118-16 (Brittany Vasquez)
Member id
UHC-60118-16
Confidence
1
Method
probabilistic
MBR-021230CLM-422454
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003010
Orphan claim re-pointed
Claims processor
CLM-417534 → UHC-19407-98 (Jose Ryan)
Member id
UHC-19407-98
Confidence
0.98
Method
probabilistic
MBR-004235CLM-417534
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003011
Orphan claim re-pointed
Claims processor
CLM-401630 → UHC-29560-29 (Kathleen Harrison)
Member id
UHC-29560-29
Confidence
0.87
Method
probabilistic
MBR-026135CLM-401630
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003012
Orphan claim re-pointed
Claims processor
CLM-420106 → UHC-03354-04 (Zachary Marshall)
Member id
UHC-03354-04
Confidence
1
Method
probabilistic
MBR-003636CLM-420106
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003013
Orphan claim re-pointed
Claims processor
CLM-413531 → UHC-69055-38 (Brian Parker)
Member id
UHC-69055-38
Confidence
0.98
Method
probabilistic
MBR-016489CLM-413531
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003014
Orphan claim re-pointed
Claims processor
CLM-423000 → UHC-81991-63 (Ashley Castro)
Member id
UHC-81991-63
Confidence
0.97
Method
deterministic
MBR-010521CLM-423000
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003015
Orphan claim re-pointed
Claims processor
CLM-427265 → UHC-04166-33 (Doris Ryan)
Member id
UHC-04166-33
Confidence
1
Method
probabilistic
MBR-022875CLM-427265
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003016
Orphan claim re-pointed
Claims processor
CLM-412034 → UHC-43336-98 (Yuki Hunter)
Member id
UHC-43336-98
Confidence
0.99
Method
probabilistic
MBR-003149CLM-412034
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003017
Orphan claim re-pointed
Claims processor
CLM-402646 → UHC-64475-41 (Joyce Armstrong)
Member id
UHC-64475-41
Confidence
1
Method
probabilistic
MBR-023292CLM-402646
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003018
Orphan claim re-pointed
Claims processor
CLM-426943 → UHC-58714-09 (Katherine Butler)
Member id
UHC-58714-09
Confidence
1
Method
probabilistic
MBR-004692CLM-426943
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003019
Orphan claim re-pointed
Claims processor
CLM-400534 → UHC-65574-14 (Carl Jacobs)
Member id
UHC-65574-14
Confidence
0.97
Method
deterministic
MBR-007410CLM-400534
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003020
Orphan claim re-pointed
Claims processor
CLM-420994 → UHC-50500-21 (Ruth Mills)
Member id
UHC-50500-21
Confidence
1
Method
probabilistic
MBR-012518CLM-420994
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003021
Orphan claim re-pointed
Claims processor
CLM-416428 → UHC-43474-82 (Ralph Dunn)
Member id
UHC-43474-82
Confidence
1
Method
probabilistic
MBR-003579CLM-416428
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003022
Orphan claim re-pointed
Claims processor
CLM-425959 → UHC-03338-45 (Aisha Sullivan)
Member id
UHC-03338-45
Confidence
0.99
Method
probabilistic
MBR-011599CLM-425959
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003023
Orphan claim re-pointed
Claims processor
CLM-419063 → UHC-44726-52 (Wayne Lopez)
Member id
UHC-44726-52
Confidence
1
Method
probabilistic
MBR-018949CLM-419063
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003024
Orphan claim re-pointed
Claims processor
CLM-424316 → UHC-64314-13 (Emily Ortega)
Member id
UHC-64314-13
Confidence
1
Method
probabilistic
MBR-012619CLM-424316
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003025
Orphan claim re-pointed
Claims processor
CLM-424816 → UHC-78961-66 (Amy Mendoza)
Member id
UHC-78961-66
Confidence
1
Method
probabilistic
MBR-026526CLM-424816
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003026
Orphan claim re-pointed
Claims processor
CLM-422979 → UHC-73169-03 (Kayla Greene)
Member id
UHC-73169-03
Confidence
1
Method
probabilistic
MBR-023135CLM-422979
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003027
Orphan claim re-pointed
Claims processor
CLM-409339 → UHC-15649-07 (Bryan Boyd)
Member id
UHC-15649-07
Confidence
1
Method
probabilistic
MBR-011709CLM-409339
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003028
Orphan claim re-pointed
Claims processor
CLM-429574 → UHC-49733-88 (Dorothy Gray)
Member id
UHC-49733-88
Confidence
1
Method
probabilistic
MBR-018240CLM-429574
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003029
Orphan claim re-pointed
Claims processor
CLM-409160 → UHC-82037-47 (Evelyn Austin)
Member id
UHC-82037-47
Confidence
1
Method
probabilistic
MBR-035769CLM-409160
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003030
Orphan claim re-pointed
Claims processor
CLM-429965 → UHC-63818-98 (Janice Smith)
Member id
UHC-63818-98
Confidence
1
Method
probabilistic
MBR-027423CLM-429965
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003031
Orphan claim re-pointed
Claims processor
CLM-429271 → UHC-24025-42 (Kayla Dominguez)
Member id
UHC-24025-42
Confidence
0.97
Method
deterministic
MBR-021842CLM-429271
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003032
Orphan claim re-pointed
Claims processor
CLM-403747 → UHC-17557-30 (Cynthia Castro)
Member id
UHC-17557-30
Confidence
1
Method
probabilistic
MBR-004496CLM-403747
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003033
Orphan claim re-pointed
Claims processor
CLM-404781 → UHC-69416-72 (Elijah Bishop)
Member id
UHC-69416-72
Confidence
1
Method
probabilistic
MBR-037465CLM-404781
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003034
Orphan claim re-pointed
Claims processor
CLM-409502 → UHC-68420-99 (Adam Evans)
Member id
UHC-68420-99
Confidence
1
Method
probabilistic
MBR-018633CLM-409502
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003035
Orphan claim re-pointed
Claims processor
CLM-404092 → UHC-44276-58 (Jeremy Richards)
Member id
UHC-44276-58
Confidence
1
Method
probabilistic
MBR-011170CLM-404092
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003036
Orphan claim re-pointed
Claims processor
CLM-414055 → UHC-64849-57 (Katherine Rivera)
Member id
UHC-64849-57
Confidence
1
Method
probabilistic
MBR-012437CLM-414055
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003037
Orphan claim re-pointed
Claims processor
CLM-413402 → UHC-92235-70 (Michelle Lee)
Member id
UHC-92235-70
Confidence
1
Method
probabilistic
MBR-014486CLM-413402
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003038
Orphan claim re-pointed
Claims processor
CLM-432603 → UHC-21303-62 (Maria Perry)
Member id
UHC-21303-62
Confidence
0.99
Method
probabilistic
MBR-001956CLM-432603
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003039
Orphan claim re-pointed
Claims processor
CLM-426193 → UHC-55817-74 (Stephen Meyer)
Member id
UHC-55817-74
Confidence
0.97
Method
deterministic
MBR-034718CLM-426193
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 34 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.