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-004090
Orphan claim re-pointed
Claims processor
CLM-412195 → UHC-50591-44 (Andrew Gibson)
Member id
UHC-50591-44
Confidence
0.92
Method
probabilistic
MBR-007670CLM-412195
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004091
Orphan claim re-pointed
Claims processor
CLM-418745 → UHC-46631-14 (Marilyn Barnes)
Member id
UHC-46631-14
Confidence
0.89
Method
probabilistic
MBR-044265CLM-418745
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004092
Orphan claim re-pointed
Claims processor
CLM-415760 → UHC-95902-85 (Michael Anderson)
Member id
UHC-95902-85
Confidence
1
Method
probabilistic
MBR-006667CLM-415760
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004093
Orphan claim re-pointed
Claims processor
CLM-405581 → UHC-80972-01 (Hiroshi Espinoza)
Member id
UHC-80972-01
Confidence
1
Method
probabilistic
MBR-009281CLM-405581
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004094
Orphan claim re-pointed
Claims processor
CLM-411406 → UHC-99708-59 (Timothy Howell)
Member id
UHC-99708-59
Confidence
0.97
Method
deterministic
MBR-032109CLM-411406
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004095
Orphan claim re-pointed
Claims processor
CLM-412610 → UHC-85547-14 (Christopher Chavez)
Member id
UHC-85547-14
Confidence
0.97
Method
deterministic
MBR-006103CLM-412610
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004096
Orphan claim re-pointed
Claims processor
CLM-408858 → UHC-34441-71 (Luis Cox)
Member id
UHC-34441-71
Confidence
1
Method
probabilistic
MBR-038509CLM-408858
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004097
Orphan claim re-pointed
Claims processor
CLM-418742 → UHC-17595-06 (Ronald Long)
Member id
UHC-17595-06
Confidence
1
Method
probabilistic
MBR-024955CLM-418742
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004098
Orphan claim re-pointed
Claims processor
CLM-415822 → UHC-68765-36 (Diane Snyder)
Member id
UHC-68765-36
Confidence
1
Method
probabilistic
MBR-032467CLM-415822
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004099
Orphan claim re-pointed
Claims processor
CLM-402827 → UHC-16007-69 (Ruth Wells)
Member id
UHC-16007-69
Confidence
1
Method
probabilistic
MBR-018582CLM-402827
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004100
Orphan claim re-pointed
Claims processor
CLM-418297 → UHC-16985-12 (Linda Obrien)
Member id
UHC-16985-12
Confidence
1
Method
probabilistic
MBR-005356CLM-418297
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004101
Orphan claim re-pointed
Claims processor
CLM-403371 → UHC-46436-46 (Julia Dean)
Member id
UHC-46436-46
Confidence
1
Method
probabilistic
MBR-010733CLM-403371
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004102
Orphan claim re-pointed
Claims processor
CLM-415147 → UHC-51560-75 (Aaron Evans)
Member id
UHC-51560-75
Confidence
1
Method
probabilistic
MBR-028645CLM-415147
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004103
Orphan claim re-pointed
Claims processor
CLM-405903 → UHC-32257-08 (Alexander Reed)
Member id
UHC-32257-08
Confidence
1
Method
probabilistic
MBR-012168CLM-405903
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004104
Orphan claim re-pointed
Claims processor
CLM-423917 → UHC-10089-20 (Lisa Wong)
Member id
UHC-10089-20
Confidence
0.98
Method
probabilistic
MBR-018974CLM-423917
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004105
Orphan claim re-pointed
Claims processor
CLM-421482 → UHC-78896-24 (Jeffrey Sims)
Member id
UHC-78896-24
Confidence
1
Method
probabilistic
MBR-018063CLM-421482
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004106
Orphan claim re-pointed
Claims processor
CLM-426062 → UHC-87673-57 (Amanda Little)
Member id
UHC-87673-57
Confidence
0.93
Method
probabilistic
MBR-022181CLM-426062
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004107
Orphan claim re-pointed
Claims processor
CLM-424846 → UHC-25707-51 (Michelle Gutierrez)
Member id
UHC-25707-51
Confidence
1
Method
probabilistic
MBR-011893CLM-424846
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004108
Orphan claim re-pointed
Claims processor
CLM-429517 → UHC-80595-34 (Julia Luna)
Member id
UHC-80595-34
Confidence
1
Method
probabilistic
MBR-006921CLM-429517
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004109
Orphan claim re-pointed
Claims processor
CLM-400800 → UHC-42409-28 (Laura Sullivan)
Member id
UHC-42409-28
Confidence
1
Method
probabilistic
MBR-000220CLM-400800
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004110
Orphan claim re-pointed
Claims processor
CLM-402893 → UHC-01879-27 (Christian Wilson)
Member id
UHC-01879-27
Confidence
0.99
Method
probabilistic
MBR-020403CLM-402893
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004111
Orphan claim re-pointed
Claims processor
CLM-429726 → UHC-15473-96 (Charlotte Rojas)
Member id
UHC-15473-96
Confidence
0.97
Method
deterministic
MBR-041293CLM-429726
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004112
Orphan claim re-pointed
Claims processor
CLM-421815 → UHC-31609-15 (Willie Allen)
Member id
UHC-31609-15
Confidence
1
Method
probabilistic
MBR-026954CLM-421815
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004113
Orphan claim re-pointed
Claims processor
CLM-417498 → UHC-97981-14 (Emily Williams)
Member id
UHC-97981-14
Confidence
0.89
Method
probabilistic
MBR-023514CLM-417498
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004114
Orphan claim re-pointed
Claims processor
CLM-423968 → UHC-77804-72 (Jonathan Dominguez)
Member id
UHC-77804-72
Confidence
1
Method
probabilistic
MBR-018373CLM-423968
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004115
Orphan claim re-pointed
Claims processor
CLM-404858 → UHC-20418-29 (Arthur Harris)
Member id
UHC-20418-29
Confidence
1
Method
probabilistic
MBR-012217CLM-404858
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004116
Orphan claim re-pointed
Claims processor
CLM-427110 → UHC-98826-91 (Isabella Barnes)
Member id
UHC-98826-91
Confidence
0.97
Method
deterministic
MBR-018152CLM-427110
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004117
Orphan claim re-pointed
Claims processor
CLM-405993 → UHC-85275-26 (Lauren Taylor)
Member id
UHC-85275-26
Confidence
1
Method
probabilistic
MBR-012308CLM-405993
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004118
Orphan claim re-pointed
Claims processor
CLM-421922 → UHC-34912-88 (Theresa Henry)
Member id
UHC-34912-88
Confidence
1
Method
probabilistic
MBR-016456CLM-421922
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004119
Orphan claim re-pointed
Claims processor
CLM-412852 → UHC-02361-56 (Judith Vasquez)
Member id
UHC-02361-56
Confidence
1
Method
probabilistic
MBR-001640CLM-412852
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004120
Orphan claim re-pointed
Claims processor
CLM-422228 → UHC-14730-39 (Gerald Hicks)
Member id
UHC-14730-39
Confidence
0.99
Method
probabilistic
MBR-017162CLM-422228
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004121
Orphan claim re-pointed
Claims processor
CLM-414280 → UHC-32071-63 (Linda Torres)
Member id
UHC-32071-63
Confidence
1
Method
probabilistic
MBR-013316CLM-414280
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004122
Orphan claim re-pointed
Claims processor
CLM-408013 → UHC-05946-53 (Rachel Romero)
Member id
UHC-05946-53
Confidence
0.91
Method
probabilistic
MBR-010768CLM-408013
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004123
Orphan claim re-pointed
Claims processor
CLM-425352 → UHC-78785-52 (Carl Hunt)
Member id
UHC-78785-52
Confidence
0.97
Method
deterministic
MBR-024849CLM-425352
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004124
Orphan claim re-pointed
Claims processor
CLM-411381 → UHC-09658-23 (Jdy Miller)
Member id
UHC-09658-23
Confidence
0.99
Method
probabilistic
MBR-001952CLM-411381
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004125
Orphan claim re-pointed
Claims processor
CLM-405391 → UHC-48174-87 (Andrew Burke)
Member id
UHC-48174-87
Confidence
0.97
Method
deterministic
MBR-002726CLM-405391
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004126
Orphan claim re-pointed
Claims processor
CLM-412175 → UHC-36745-76 (Sean Fuller)
Member id
UHC-36745-76
Confidence
1
Method
probabilistic
MBR-005429CLM-412175
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004127
Orphan claim re-pointed
Claims processor
CLM-424716 → UHC-15360-01 (Daniel Jordan)
Member id
UHC-15360-01
Confidence
1
Method
probabilistic
MBR-009084CLM-424716
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004128
Orphan claim re-pointed
Claims processor
CLM-428919 → UHC-26103-13 (Austin Willis)
Member id
UHC-26103-13
Confidence
1
Method
probabilistic
MBR-006266CLM-428919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004129
Orphan claim re-pointed
Claims processor
CLM-408847 → UHC-95280-49 (Diego Parker)
Member id
UHC-95280-49
Confidence
0.97
Method
deterministic
MBR-026110CLM-408847
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004130
Orphan claim re-pointed
Claims processor
CLM-419388 → UHC-95109-52 (Shirley Gutierrez)
Member id
UHC-95109-52
Confidence
1
Method
probabilistic
MBR-012249CLM-419388
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004131
Orphan claim re-pointed
Claims processor
CLM-405340 → UHC-27600-40 (Luis Hill)
Member id
UHC-27600-40
Confidence
0.97
Method
deterministic
MBR-010983CLM-405340
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004132
Orphan claim re-pointed
Claims processor
CLM-420432 → UHC-14557-08 (Charles Little)
Member id
UHC-14557-08
Confidence
0.97
Method
deterministic
MBR-006556CLM-420432
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004133
Orphan claim re-pointed
Claims processor
CLM-404561 → UHC-45682-55 (David Daniels)
Member id
UHC-45682-55
Confidence
0.97
Method
deterministic
MBR-003333CLM-404561
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004134
Orphan claim re-pointed
Claims processor
CLM-432318 → UHC-10590-48 (Emma Fields)
Member id
UHC-10590-48
Confidence
0.99
Method
probabilistic
MBR-006736CLM-432318
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004135
Orphan claim re-pointed
Claims processor
CLM-402868 → UHC-31158-95 (Danielle Ruiz)
Member id
UHC-31158-95
Confidence
0.97
Method
deterministic
MBR-003133CLM-402868
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004136
Orphan claim re-pointed
Claims processor
CLM-424370 → UHC-28455-24 (Peter Alvarez)
Member id
UHC-28455-24
Confidence
1
Method
probabilistic
MBR-022797CLM-424370
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004137
Orphan claim re-pointed
Claims processor
CLM-424928 → UHC-91159-53 (Diane George)
Member id
UHC-91159-53
Confidence
1
Method
probabilistic
MBR-032361CLM-424928
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004138
Orphan claim re-pointed
Claims processor
CLM-408665 → UHC-99908-37 (Mary George)
Member id
UHC-99908-37
Confidence
0.97
Method
deterministic
MBR-000829CLM-408665
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004139
Orphan claim re-pointed
Claims processor
CLM-411741 → UHC-26060-45 (Priya Tucker)
Member id
UHC-26060-45
Confidence
1
Method
probabilistic
MBR-001814CLM-411741
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 56 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.