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-003640
Orphan claim re-pointed
Claims processor
CLM-432759 → UHC-82685-52 (Randy Nunez)
Member id
UHC-82685-52
Confidence
1
Method
probabilistic
MBR-042589CLM-432759
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003641
Orphan claim re-pointed
Claims processor
CLM-410499 → UHC-93692-17 (Isabella Ramirez)
Member id
UHC-93692-17
Confidence
1
Method
probabilistic
MBR-031437CLM-410499
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003642
Orphan claim re-pointed
Claims processor
CLM-412023 → UHC-91736-60 (Randy Sims)
Member id
UHC-91736-60
Confidence
1
Method
probabilistic
MBR-012073CLM-412023
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003643
Orphan claim re-pointed
Claims processor
CLM-427697 → UHC-53069-38 (Billy Henderson)
Member id
UHC-53069-38
Confidence
1
Method
probabilistic
MBR-002934CLM-427697
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003644
Orphan claim re-pointed
Claims processor
CLM-408604 → UHC-10171-50 (Robert Palmer)
Member id
UHC-10171-50
Confidence
0.97
Method
deterministic
MBR-001934CLM-408604
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003645
Orphan claim re-pointed
Claims processor
CLM-404533 → UHC-53774-63 (Hiroshi Kelley)
Member id
UHC-53774-63
Confidence
1
Method
probabilistic
MBR-022485CLM-404533
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003646
Orphan claim re-pointed
Claims processor
CLM-415101 → UHC-24537-63 (Michelle Lee)
Member id
UHC-24537-63
Confidence
0.93
Method
probabilistic
MBR-019450CLM-415101
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003647
Orphan claim re-pointed
Claims processor
CLM-405483 → UHC-96934-23 (Thomas Powell)
Member id
UHC-96934-23
Confidence
1
Method
probabilistic
MBR-019887CLM-405483
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003648
Orphan claim re-pointed
Claims processor
CLM-420815 → UHC-62165-37 (Alexander Harris)
Member id
UHC-62165-37
Confidence
0.97
Method
deterministic
MBR-024086CLM-420815
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003649
Orphan claim re-pointed
Claims processor
CLM-421897 → UHC-32702-07 (Martha Watson)
Member id
UHC-32702-07
Confidence
0.93
Method
probabilistic
MBR-020296CLM-421897
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003650
Orphan claim re-pointed
Claims processor
CLM-402249 → UHC-27907-28 (Charlotte Alvarez)
Member id
UHC-27907-28
Confidence
1
Method
probabilistic
MBR-034019CLM-402249
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003651
Orphan claim re-pointed
Claims processor
CLM-422591 → UHC-73740-43 (Julie Ryan)
Member id
UHC-73740-43
Confidence
0.97
Method
deterministic
MBR-011723CLM-422591
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003652
Orphan claim re-pointed
Claims processor
CLM-414483 → UHC-36583-04 (Joan Torres)
Member id
UHC-36583-04
Confidence
0.99
Method
probabilistic
MBR-006817CLM-414483
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003653
Orphan claim re-pointed
Claims processor
CLM-404782 → UHC-06843-43 (Mateo Jensen)
Member id
UHC-06843-43
Confidence
1
Method
probabilistic
MBR-037366CLM-404782
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003654
Orphan claim re-pointed
Claims processor
CLM-409622 → UHC-67568-05 (Larry Moore)
Member id
UHC-67568-05
Confidence
0.97
Method
deterministic
MBR-005293CLM-409622
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003655
Orphan claim re-pointed
Claims processor
CLM-424788 → UHC-30287-02 (Camila Coleman)
Member id
UHC-30287-02
Confidence
1
Method
probabilistic
MBR-000095CLM-424788
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003656
Orphan claim re-pointed
Claims processor
CLM-421432 → UHC-17147-62 (Lucia Vazquez)
Member id
UHC-17147-62
Confidence
1
Method
probabilistic
MBR-031282CLM-421432
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003657
Orphan claim re-pointed
Claims processor
CLM-425631 → UHC-08115-31 (Emily Dunn)
Member id
UHC-08115-31
Confidence
1
Method
probabilistic
MBR-005095CLM-425631
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003658
Orphan claim re-pointed
Claims processor
CLM-422605 → UHC-33618-37 (Dylan Ramos)
Member id
UHC-33618-37
Confidence
1
Method
probabilistic
MBR-015610CLM-422605
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003659
Orphan claim re-pointed
Claims processor
CLM-423888 → UHC-91198-73 (Judy Montgomery)
Member id
UHC-91198-73
Confidence
1
Method
probabilistic
MBR-004286CLM-423888
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003660
Orphan claim re-pointed
Claims processor
CLM-422023 → UHC-79280-23 (Ryan Edwards)
Member id
UHC-79280-23
Confidence
1
Method
probabilistic
MBR-006135CLM-422023
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003661
Orphan claim re-pointed
Claims processor
CLM-428836 → UHC-77677-08 (Ashley Walsh)
Member id
UHC-77677-08
Confidence
0.93
Method
probabilistic
MBR-013463CLM-428836
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003662
Orphan claim re-pointed
Claims processor
CLM-421805 → UHC-53009-43 (Helen Watson)
Member id
UHC-53009-43
Confidence
1
Method
probabilistic
MBR-013206CLM-421805
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003663
Orphan claim re-pointed
Claims processor
CLM-405989 → UHC-44961-96 (Joshua Marshall)
Member id
UHC-44961-96
Confidence
1
Method
probabilistic
MBR-004664CLM-405989
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003664
Orphan claim re-pointed
Claims processor
CLM-409659 → UHC-58614-40 (Alexander Wells)
Member id
UHC-58614-40
Confidence
1
Method
probabilistic
MBR-030523CLM-409659
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003665
Orphan claim re-pointed
Claims processor
CLM-427248 → UHC-50874-41 (Bruce Vega)
Member id
UHC-50874-41
Confidence
0.98
Method
probabilistic
MBR-027039CLM-427248
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003666
Orphan claim re-pointed
Claims processor
CLM-410039 → UHC-72396-45 (Jason Mills)
Member id
UHC-72396-45
Confidence
1
Method
probabilistic
MBR-003404CLM-410039
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003667
Orphan claim re-pointed
Claims processor
CLM-409229 → UHC-28152-67 (Joe Castillo)
Member id
UHC-28152-67
Confidence
1
Method
probabilistic
MBR-007770CLM-409229
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003668
Orphan claim re-pointed
Claims processor
CLM-423702 → UHC-81831-31 (Kathleen Day)
Member id
UHC-81831-31
Confidence
1
Method
probabilistic
MBR-017970CLM-423702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003669
Orphan claim re-pointed
Claims processor
CLM-423118 → UHC-47110-21 (Barbara Reed)
Member id
UHC-47110-21
Confidence
0.94
Method
probabilistic
MBR-007366CLM-423118
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003670
Orphan claim re-pointed
Claims processor
CLM-406790 → UHC-28167-34 (Jacqueline Burke)
Member id
UHC-28167-34
Confidence
1
Method
probabilistic
MBR-000596CLM-406790
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003671
Orphan claim re-pointed
Claims processor
CLM-411670 → UHC-67995-44 (Donna Stephens)
Member id
UHC-67995-44
Confidence
1
Method
probabilistic
MBR-007193CLM-411670
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003672
Orphan claim re-pointed
Claims processor
CLM-417822 → UHC-89751-57 (Aisha Nguyen)
Member id
UHC-89751-57
Confidence
0.97
Method
deterministic
MBR-034691CLM-417822
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003673
Orphan claim re-pointed
Claims processor
CLM-403008 → UHC-91652-15 (Ryan Little)
Member id
UHC-91652-15
Confidence
0.97
Method
deterministic
MBR-003074CLM-403008
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003674
Orphan claim re-pointed
Claims processor
CLM-422829 → UHC-77203-39 (Elijah Young)
Member id
UHC-77203-39
Confidence
0.97
Method
deterministic
MBR-003260CLM-422829
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003675
Orphan claim re-pointed
Claims processor
CLM-405768 → UHC-27527-73 (Henry Mendez)
Member id
UHC-27527-73
Confidence
0.93
Method
probabilistic
MBR-036163CLM-405768
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003676
Orphan claim re-pointed
Claims processor
CLM-415123 → UHC-96249-54 (Timothy Brooks)
Member id
UHC-96249-54
Confidence
1
Method
probabilistic
MBR-015364CLM-415123
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003677
Orphan claim re-pointed
Claims processor
CLM-421001 → UHC-02986-81 (Tyler Reed)
Member id
UHC-02986-81
Confidence
1
Method
probabilistic
MBR-012953CLM-421001
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003678
Orphan claim re-pointed
Claims processor
CLM-402132 → UHC-01248-43 (Diane Stone)
Member id
UHC-01248-43
Confidence
1
Method
probabilistic
MBR-023077CLM-402132
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003679
Orphan claim re-pointed
Claims processor
CLM-419903 → UHC-69124-67 (Kathryn Robinson)
Member id
UHC-69124-67
Confidence
1
Method
probabilistic
MBR-003509CLM-419903
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003680
Orphan claim re-pointed
Claims processor
CLM-424012 → UHC-97185-04 (Marcus Ramirez)
Member id
UHC-97185-04
Confidence
1
Method
probabilistic
MBR-029734CLM-424012
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003681
Orphan claim re-pointed
Claims processor
CLM-401254 → UHC-20075-24 (Maria Washington)
Member id
UHC-20075-24
Confidence
1
Method
probabilistic
MBR-022549CLM-401254
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003682
Orphan claim re-pointed
Claims processor
CLM-428231 → UHC-45079-43 (Jerry Dunn)
Member id
UHC-45079-43
Confidence
1
Method
probabilistic
MBR-006905CLM-428231
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003683
Orphan claim re-pointed
Claims processor
CLM-417403 → UHC-29632-13 (Terry Le)
Member id
UHC-29632-13
Confidence
1
Method
probabilistic
MBR-035023CLM-417403
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003684
Orphan claim re-pointed
Claims processor
CLM-404071 → UHC-81271-92 (Ryan Jimenez)
Member id
UHC-81271-92
Confidence
1
Method
probabilistic
MBR-011638CLM-404071
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003685
Orphan claim re-pointed
Claims processor
CLM-401546 → UHC-15951-28 (Michael Clark)
Member id
UHC-15951-28
Confidence
1
Method
probabilistic
MBR-017910CLM-401546
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003686
Orphan claim re-pointed
Claims processor
CLM-401003 → UHC-52621-90 (Charles Kelly)
Member id
UHC-52621-90
Confidence
0.93
Method
probabilistic
MBR-009796CLM-401003
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003687
Orphan claim re-pointed
Claims processor
CLM-418217 → UHC-15372-66 (Jason Murphy)
Member id
UHC-15372-66
Confidence
0.99
Method
probabilistic
MBR-004902CLM-418217
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003688
Orphan claim re-pointed
Claims processor
CLM-412241 → UHC-40023-82 (Victoria Ross)
Member id
UHC-40023-82
Confidence
1
Method
probabilistic
MBR-007791CLM-412241
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003689
Orphan claim re-pointed
Claims processor
CLM-430699 → UHC-62633-54 (Alexnader Le)
Member id
UHC-62633-54
Confidence
0.99
Method
probabilistic
MBR-029118CLM-430699
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 47 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.