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-003290
Orphan claim re-pointed
Claims processor
CLM-404674 → UHC-87798-97 (Sophia Hill)
Member id
UHC-87798-97
Confidence
0.97
Method
deterministic
MBR-002649CLM-404674
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003291
Orphan claim re-pointed
Claims processor
CLM-401570 → UHC-28829-66 (David Graham)
Member id
UHC-28829-66
Confidence
1
Method
probabilistic
MBR-013708CLM-401570
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003292
Orphan claim re-pointed
Claims processor
CLM-424731 → UHC-00426-62 (Philip Willis)
Member id
UHC-00426-62
Confidence
1
Method
probabilistic
MBR-031881CLM-424731
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003293
Orphan claim re-pointed
Claims processor
CLM-401225 → UHC-75662-02 (Ann Lopez)
Member id
UHC-75662-02
Confidence
1
Method
probabilistic
MBR-005039CLM-401225
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003294
Orphan claim re-pointed
Claims processor
CLM-403730 → UHC-02004-26 (Jessica Berry)
Member id
UHC-02004-26
Confidence
0.99
Method
probabilistic
MBR-014705CLM-403730
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003295
Orphan claim re-pointed
Claims processor
CLM-427057 → UHC-13302-16 (Jason Jacobs)
Member id
UHC-13302-16
Confidence
0.97
Method
deterministic
MBR-011413CLM-427057
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003296
Orphan claim re-pointed
Claims processor
CLM-418977 → UHC-62532-33 (Sarah Luna)
Member id
UHC-62532-33
Confidence
0.97
Method
deterministic
MBR-005119CLM-418977
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003297
Orphan claim re-pointed
Claims processor
CLM-424308 → UHC-11160-33 (Wei Morrison)
Member id
UHC-11160-33
Confidence
1
Method
probabilistic
MBR-006666CLM-424308
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003298
Orphan claim re-pointed
Claims processor
CLM-417648 → UHC-20851-36 (Olivia Gilbert)
Member id
UHC-20851-36
Confidence
1
Method
probabilistic
MBR-003905CLM-417648
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003299
Orphan claim re-pointed
Claims processor
CLM-426370 → UHC-69885-08 (Mei Reyes)
Member id
UHC-69885-08
Confidence
0.97
Method
deterministic
MBR-010207CLM-426370
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003300
Orphan claim re-pointed
Claims processor
CLM-415060 → UHC-00530-80 (Diana Russell)
Member id
UHC-00530-80
Confidence
1
Method
probabilistic
MBR-028526CLM-415060
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003301
Orphan claim re-pointed
Claims processor
CLM-409577 → UHC-89088-77 (Guzman Kathryn)
Member id
UHC-89088-77
Confidence
0.98
Method
probabilistic
MBR-017695CLM-409577
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003302
Orphan claim re-pointed
Claims processor
CLM-405131 → UHC-93283-17 (Carl Davis)
Member id
UHC-93283-17
Confidence
1
Method
probabilistic
MBR-002767CLM-405131
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003303
Orphan claim re-pointed
Claims processor
CLM-403602 → UHC-73331-86 (Mary Edwards)
Member id
UHC-73331-86
Confidence
0.97
Method
deterministic
MBR-024000CLM-403602
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003304
Orphan claim re-pointed
Claims processor
CLM-408637 → UHC-25366-78 (Jonathan Carlson)
Member id
UHC-25366-78
Confidence
1
Method
probabilistic
MBR-010370CLM-408637
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003305
Orphan claim re-pointed
Claims processor
CLM-420527 → UHC-53502-65 (George Lopez)
Member id
UHC-53502-65
Confidence
0.97
Method
deterministic
MBR-022564CLM-420527
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003306
Orphan claim re-pointed
Claims processor
CLM-424163 → UHC-81991-36 (Gary Larson)
Member id
UHC-81991-36
Confidence
1
Method
probabilistic
MBR-021011CLM-424163
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003307
Orphan claim re-pointed
Claims processor
CLM-409400 → UHC-69356-13 (Arjun Sullivan)
Member id
UHC-69356-13
Confidence
1
Method
probabilistic
MBR-005474CLM-409400
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003308
Orphan claim re-pointed
Claims processor
CLM-413465 → UHC-35456-26 (Isabella Nelson)
Member id
UHC-35456-26
Confidence
1
Method
probabilistic
MBR-013260CLM-413465
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003309
Orphan claim re-pointed
Claims processor
CLM-425351 → UHC-78785-52 (Carl Hunt)
Member id
UHC-78785-52
Confidence
0.97
Method
deterministic
MBR-024849CLM-425351
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003310
Orphan claim re-pointed
Claims processor
CLM-410953 → UHC-08945-48 (Alexander Diaz)
Member id
UHC-08945-48
Confidence
0.97
Method
deterministic
MBR-013687CLM-410953
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003311
Orphan claim re-pointed
Claims processor
CLM-402546 → UHC-93710-38 (Jennifer Baker)
Member id
UHC-93710-38
Confidence
1
Method
probabilistic
MBR-025389CLM-402546
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003312
Orphan claim re-pointed
Claims processor
CLM-426527 → UHC-96480-12 (Stephanie Moore)
Member id
UHC-96480-12
Confidence
1
Method
probabilistic
MBR-020297CLM-426527
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003313
Orphan claim re-pointed
Claims processor
CLM-432546 → UHC-65896-08 (Jdy Wells)
Member id
UHC-65896-08
Confidence
0.99
Method
probabilistic
MBR-016154CLM-432546
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003314
Orphan claim re-pointed
Claims processor
CLM-413493 → UHC-86270-14 (Richard Greene)
Member id
UHC-86270-14
Confidence
1
Method
probabilistic
MBR-019833CLM-413493
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003315
Orphan claim re-pointed
Claims processor
CLM-427146 → UHC-29997-83 (Priya Coleman)
Member id
UHC-29997-83
Confidence
1
Method
probabilistic
MBR-013436CLM-427146
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003316
Orphan claim re-pointed
Claims processor
CLM-417793 → UHC-64715-69 (Arjun Jimenez)
Member id
UHC-64715-69
Confidence
0.97
Method
deterministic
MBR-040044CLM-417793
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003317
Orphan claim re-pointed
Claims processor
CLM-409289 → UHC-43144-61 (Benjamin Moreno)
Member id
UHC-43144-61
Confidence
1.00
Method
probabilistic
MBR-003895CLM-409289
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003318
Orphan claim re-pointed
Claims processor
CLM-425111 → UHC-46808-74 (Teresa Rivera)
Member id
UHC-46808-74
Confidence
1
Method
probabilistic
MBR-022872CLM-425111
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003319
Orphan claim re-pointed
Claims processor
CLM-405871 → UHC-12735-84 (Ralph Williamson)
Member id
UHC-12735-84
Confidence
1
Method
probabilistic
MBR-014765CLM-405871
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003320
Orphan claim re-pointed
Claims processor
CLM-429776 → UHC-46226-50 (Daniele Stevens)
Member id
UHC-46226-50
Confidence
1.00
Method
probabilistic
MBR-028775CLM-429776
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003321
Orphan claim re-pointed
Claims processor
CLM-403679 → UHC-38568-32 (Frank Williamson)
Member id
UHC-38568-32
Confidence
0.94
Method
probabilistic
MBR-030747CLM-403679
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003322
Orphan claim re-pointed
Claims processor
CLM-402735 → UHC-42403-07 (Joe Murphy)
Member id
UHC-42403-07
Confidence
0.97
Method
deterministic
MBR-014022CLM-402735
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003323
Orphan claim re-pointed
Claims processor
CLM-414773 → UHC-22083-44 (Willie McCoy)
Member id
UHC-22083-44
Confidence
1
Method
probabilistic
MBR-000604CLM-414773
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003324
Orphan claim re-pointed
Claims processor
CLM-415795 → UHC-36240-36 (Charles Walker)
Member id
UHC-36240-36
Confidence
1
Method
probabilistic
MBR-029399CLM-415795
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003325
Orphan claim re-pointed
Claims processor
CLM-407765 → UHC-32138-49 (Kimberly Robinson)
Member id
UHC-32138-49
Confidence
1
Method
probabilistic
MBR-022303CLM-407765
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003326
Orphan claim re-pointed
Claims processor
CLM-408497 → UHC-19437-72 (Judy Wells)
Member id
UHC-19437-72
Confidence
1
Method
probabilistic
MBR-004802CLM-408497
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003327
Orphan claim re-pointed
Claims processor
CLM-425476 → UHC-10656-62 (Bobby Chen)
Member id
UHC-10656-62
Confidence
0.97
Method
deterministic
MBR-018811CLM-425476
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003328
Orphan claim re-pointed
Claims processor
CLM-413889 → UHC-09134-29 (Deborah Wang)
Member id
UHC-09134-29
Confidence
1
Method
probabilistic
MBR-044263CLM-413889
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003329
Orphan claim re-pointed
Claims processor
CLM-412067 → UHC-79382-41 (Ruth Dunn)
Member id
UHC-79382-41
Confidence
0.99
Method
probabilistic
MBR-026258CLM-412067
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003330
Orphan claim re-pointed
Claims processor
CLM-424185 → UHC-21057-88 (Cheryl Gray)
Member id
UHC-21057-88
Confidence
1
Method
probabilistic
MBR-013278CLM-424185
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003331
Orphan claim re-pointed
Claims processor
CLM-424925 → UHC-97244-05 (Doris Ford)
Member id
UHC-97244-05
Confidence
0.94
Method
probabilistic
MBR-012620CLM-424925
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003332
Orphan claim re-pointed
Claims processor
CLM-415358 → UHC-19167-90 (Bobby Gilbert)
Member id
UHC-19167-90
Confidence
0.97
Method
deterministic
MBR-000180CLM-415358
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003333
Orphan claim re-pointed
Claims processor
CLM-419913 → UHC-68580-40 (Cynthia Jimenez)
Member id
UHC-68580-40
Confidence
1
Method
probabilistic
MBR-027920CLM-419913
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003334
Orphan claim re-pointed
Claims processor
CLM-409617 → UHC-70330-92 (Albert Hayes)
Member id
UHC-70330-92
Confidence
1
Method
probabilistic
MBR-011061CLM-409617
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003335
Orphan claim re-pointed
Claims processor
CLM-431176 → UHC-86368-16 (Mateo Harvey)
Member id
UHC-86368-16
Confidence
0.99
Method
probabilistic
MBR-000632CLM-431176
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003336
Orphan claim re-pointed
Claims processor
CLM-410434 → UHC-98014-78 (Emma Hawkins)
Member id
UHC-98014-78
Confidence
1
Method
probabilistic
MBR-017537CLM-410434
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003337
Orphan claim re-pointed
Claims processor
CLM-403285 → UHC-52805-66 (Judith Gilbert)
Member id
UHC-52805-66
Confidence
1
Method
probabilistic
MBR-017753CLM-403285
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003338
Orphan claim re-pointed
Claims processor
CLM-410973 → UHC-29968-36 (Thomas Stephens)
Member id
UHC-29968-36
Confidence
1
Method
probabilistic
MBR-015328CLM-410973
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003339
Orphan claim re-pointed
Claims processor
CLM-415500 → UHC-71089-33 (Sharon Simmons)
Member id
UHC-71089-33
Confidence
1
Method
probabilistic
MBR-025732CLM-415500
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 40 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.