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-004390
Orphan claim re-pointed
Claims processor
CLM-423417 → UHC-62843-17 (Emily Snyder)
Member id
UHC-62843-17
Confidence
1
Method
probabilistic
MBR-014892CLM-423417
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004391
Orphan claim re-pointed
Claims processor
CLM-429691 → UHC-70178-05 (Ashley Ryan)
Member id
UHC-70178-05
Confidence
1
Method
probabilistic
MBR-023836CLM-429691
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004392
Orphan claim re-pointed
Claims processor
CLM-422364 → UHC-30222-93 (Ann Young)
Member id
UHC-30222-93
Confidence
1
Method
probabilistic
MBR-027407CLM-422364
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004393
Orphan claim re-pointed
Claims processor
CLM-424933 → UHC-94406-85 (Tyler Wells)
Member id
UHC-94406-85
Confidence
1
Method
probabilistic
MBR-000041CLM-424933
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004394
Orphan claim re-pointed
Claims processor
CLM-411876 → UHC-36360-26 (Theresa Cruz)
Member id
UHC-36360-26
Confidence
1
Method
probabilistic
MBR-007332CLM-411876
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004395
Orphan claim re-pointed
Claims processor
CLM-430481 → UHC-37303-83 (Alan Lopez)
Member id
UHC-37303-83
Confidence
1
Method
probabilistic
MBR-026491CLM-430481
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004396
Orphan claim re-pointed
Claims processor
CLM-402538 → UHC-62141-75 (Billy Green)
Member id
UHC-62141-75
Confidence
0.97
Method
deterministic
MBR-006938CLM-402538
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004397
Orphan claim re-pointed
Claims processor
CLM-407586 → UHC-91617-74 (Albert Murray)
Member id
UHC-91617-74
Confidence
1
Method
probabilistic
MBR-002154CLM-407586
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004398
Orphan claim re-pointed
Claims processor
CLM-426540 → UHC-03403-79 (Douglas Harris)
Member id
UHC-03403-79
Confidence
1
Method
probabilistic
MBR-026377CLM-426540
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004399
Orphan claim re-pointed
Claims processor
CLM-422603 → UHC-61347-18 (Thomas Day)
Member id
UHC-61347-18
Confidence
1
Method
probabilistic
MBR-003990CLM-422603
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004400
Orphan claim re-pointed
Claims processor
CLM-409086 → UHC-61419-84 (Kathryn Knight)
Member id
UHC-61419-84
Confidence
1
Method
probabilistic
MBR-013145CLM-409086
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004401
Orphan claim re-pointed
Claims processor
CLM-413409 → UHC-38793-60 (Bradley Martinez)
Member id
UHC-38793-60
Confidence
0.97
Method
deterministic
MBR-019398CLM-413409
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004402
Orphan claim re-pointed
Claims processor
CLM-419055 → UHC-96097-03 (Randy Flores)
Member id
UHC-96097-03
Confidence
1
Method
probabilistic
MBR-005234CLM-419055
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004403
Orphan claim re-pointed
Claims processor
CLM-426197 → UHC-50611-25 (Kathleen Boyd)
Member id
UHC-50611-25
Confidence
0.94
Method
probabilistic
MBR-032245CLM-426197
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004404
Orphan claim re-pointed
Claims processor
CLM-428927 → UHC-86763-22 (Kimberly Bell)
Member id
UHC-86763-22
Confidence
0.97
Method
deterministic
MBR-018763CLM-428927
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004405
Orphan claim re-pointed
Claims processor
CLM-411740 → UHC-26060-45 (Priya Tucker)
Member id
UHC-26060-45
Confidence
0.97
Method
deterministic
MBR-001814CLM-411740
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004406
Orphan claim re-pointed
Claims processor
CLM-421491 → UHC-33392-38 (Eugene Diaz)
Member id
UHC-33392-38
Confidence
1
Method
probabilistic
MBR-000996CLM-421491
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004407
Orphan claim re-pointed
Claims processor
CLM-428280 → UHC-51886-82 (Emily Montgomery)
Member id
UHC-51886-82
Confidence
0.97
Method
deterministic
MBR-011148CLM-428280
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004408
Orphan claim re-pointed
Claims processor
CLM-416999 → UHC-38087-84 (Daniel Jimenez)
Member id
UHC-38087-84
Confidence
1
Method
probabilistic
MBR-007268CLM-416999
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004409
Orphan claim re-pointed
Claims processor
CLM-430694 → UHC-42126-16 (Lucia Gomez)
Member id
UHC-42126-16
Confidence
1
Method
probabilistic
MBR-003739CLM-430694
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004410
Orphan claim re-pointed
Claims processor
CLM-405853 → UHC-52255-77 (Kelly Aguilar)
Member id
UHC-52255-77
Confidence
1
Method
probabilistic
MBR-007244CLM-405853
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004411
Orphan claim re-pointed
Claims processor
CLM-418738 → UHC-20447-25 (Willie Walsh)
Member id
UHC-20447-25
Confidence
0.97
Method
deterministic
MBR-017635CLM-418738
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004412
Orphan claim re-pointed
Claims processor
CLM-413133 → UHC-00195-62 (Danielle Vassquez)
Member id
UHC-00195-62
Confidence
0.97
Method
deterministic
MBR-022883CLM-413133
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004413
Orphan claim re-pointed
Claims processor
CLM-416032 → UHC-60936-79 (Marcus Tucker)
Member id
UHC-60936-79
Confidence
0.97
Method
deterministic
MBR-016840CLM-416032
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004414
Orphan claim re-pointed
Claims processor
CLM-403906 → UHC-09193-61 (Jason Cox)
Member id
UHC-09193-61
Confidence
1
Method
probabilistic
MBR-007562CLM-403906
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004415
Orphan claim re-pointed
Claims processor
CLM-429359 → UHC-23298-02 (Margaret Knight)
Member id
UHC-23298-02
Confidence
1
Method
probabilistic
MBR-006137CLM-429359
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004416
Orphan claim re-pointed
Claims processor
CLM-411628 → UHC-39760-20 (Arthur Matthews)
Member id
UHC-39760-20
Confidence
1
Method
probabilistic
MBR-030226CLM-411628
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004417
Orphan claim re-pointed
Claims processor
CLM-401416 → UHC-75918-34 (Bryan Hunter)
Member id
UHC-75918-34
Confidence
0.98
Method
probabilistic
MBR-001352CLM-401416
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004418
Orphan claim re-pointed
Claims processor
CLM-425885 → UHC-33591-20 (Bryan Dominguez)
Member id
UHC-33591-20
Confidence
1
Method
probabilistic
MBR-004609CLM-425885
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004419
Orphan claim re-pointed
Claims processor
CLM-404690 → UHC-10206-05 (Ahmed Vega)
Member id
UHC-10206-05
Confidence
0.99
Method
probabilistic
MBR-007257CLM-404690
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004420
Orphan claim re-pointed
Claims processor
CLM-421931 → UHC-83588-76 (Maria Wells)
Member id
UHC-83588-76
Confidence
1
Method
probabilistic
MBR-012710CLM-421931
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004421
Orphan claim re-pointed
Claims processor
CLM-423445 → UHC-88293-04 (Larry Salazar)
Member id
UHC-88293-04
Confidence
1
Method
probabilistic
MBR-001829CLM-423445
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004422
Orphan claim re-pointed
Claims processor
CLM-411918 → UHC-29398-05 (Julia Adams)
Member id
UHC-29398-05
Confidence
1
Method
probabilistic
MBR-006673CLM-411918
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004423
Orphan claim re-pointed
Claims processor
CLM-423614 → UHC-70899-35 (Joan Fuller)
Member id
UHC-70899-35
Confidence
1
Method
probabilistic
MBR-008388CLM-423614
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004424
Orphan claim re-pointed
Claims processor
CLM-422092 → UHC-62136-56 (Luis Romero)
Member id
UHC-62136-56
Confidence
0.97
Method
deterministic
MBR-000918CLM-422092
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004425
Orphan claim re-pointed
Claims processor
CLM-430241 → UHC-83901-95 (Austin Robinson)
Member id
UHC-83901-95
Confidence
1
Method
probabilistic
MBR-011360CLM-430241
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004426
Orphan claim re-pointed
Claims processor
CLM-419606 → UHC-82844-75 (Amy Flores)
Member id
UHC-82844-75
Confidence
0.93
Method
probabilistic
MBR-003727CLM-419606
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004427
Orphan claim re-pointed
Claims processor
CLM-400185 → UHC-36965-72 (Anthony Ross)
Member id
UHC-36965-72
Confidence
1
Method
probabilistic
MBR-037090CLM-400185
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004428
Orphan claim re-pointed
Claims processor
CLM-421676 → UHC-33647-05 (Janice Fox)
Member id
UHC-33647-05
Confidence
0.97
Method
deterministic
MBR-020381CLM-421676
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004429
Orphan claim re-pointed
Claims processor
CLM-401877 → UHC-75417-10 (Isabella Bowman)
Member id
UHC-75417-10
Confidence
1
Method
probabilistic
MBR-022935CLM-401877
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004430
Orphan claim re-pointed
Claims processor
CLM-423398 → UHC-08669-16 (Vicky Cook)
Member id
UHC-08669-16
Confidence
1
Method
probabilistic
MBR-011740CLM-423398
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004431
Orphan claim re-pointed
Claims processor
CLM-413182 → UHC-64287-90 (Roy Smith)
Member id
UHC-64287-90
Confidence
1
Method
probabilistic
MBR-021882CLM-413182
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004432
Orphan claim re-pointed
Claims processor
CLM-404395 → UHC-80671-65 (Ralph Fuller)
Member id
UHC-80671-65
Confidence
1
Method
probabilistic
MBR-006145CLM-404395
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004433
Orphan claim re-pointed
Claims processor
CLM-401430 → UHC-26415-69 (Willie Mendoza)
Member id
UHC-26415-69
Confidence
1
Method
probabilistic
MBR-015833CLM-401430
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004434
Orphan claim re-pointed
Claims processor
CLM-414841 → UHC-23904-16 (Elijah Ferguson)
Member id
UHC-23904-16
Confidence
0.97
Method
deterministic
MBR-002766CLM-414841
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004435
Orphan claim re-pointed
Claims processor
CLM-409211 → UHC-45965-92 (Jeffrey Clark)
Member id
UHC-45965-92
Confidence
1
Method
probabilistic
MBR-014631CLM-409211
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004436
Orphan claim re-pointed
Claims processor
CLM-423452 → UHC-80479-97 (Amber Wells)
Member id
UHC-80479-97
Confidence
0.97
Method
deterministic
MBR-002456CLM-423452
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004437
Orphan claim re-pointed
Claims processor
CLM-404789 → UHC-91040-77 (Bradley Schmidt)
Member id
UHC-91040-77
Confidence
1
Method
probabilistic
MBR-021729CLM-404789
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004438
Orphan claim re-pointed
Claims processor
CLM-411972 → UHC-26604-40 (Jesse Contreras)
Member id
UHC-26604-40
Confidence
0.99
Method
probabilistic
MBR-016149CLM-411972
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004439
Orphan claim re-pointed
Claims processor
CLM-425088 → UHC-27960-11 (Joan Bennett)
Member id
UHC-27960-11
Confidence
1
Method
probabilistic
MBR-010174CLM-425088
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 62 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.