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-004640
Orphan claim re-pointed
Claims processor
CLM-422511 → UHC-75523-93 (Joseph Hamilton)
Member id
UHC-75523-93
Confidence
1
Method
probabilistic
MBR-022696CLM-422511
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004641
Orphan claim re-pointed
Claims processor
CLM-415648 → UHC-79616-93 (Arthur Arnold)
Member id
UHC-79616-93
Confidence
1
Method
probabilistic
MBR-002568CLM-415648
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004642
Orphan claim re-pointed
Claims processor
CLM-414521 → UHC-46817-61 (Mateo Perez)
Member id
UHC-46817-61
Confidence
1
Method
probabilistic
MBR-017686CLM-414521
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004643
Orphan claim re-pointed
Claims processor
CLM-418486 → UHC-92698-48 (Martha Haimlton)
Member id
UHC-92698-48
Confidence
0.99
Method
probabilistic
MBR-020492CLM-418486
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004644
Orphan claim re-pointed
Claims processor
CLM-408842 → UHC-62451-86 (Berb Weaver)
Member id
UHC-62451-86
Confidence
0.96
Method
probabilistic
MBR-033011CLM-408842
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004645
Orphan claim re-pointed
Claims processor
CLM-415807 → UHC-39950-19 (Karen Woods)
Member id
UHC-39950-19
Confidence
0.97
Method
deterministic
MBR-024957CLM-415807
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004646
Orphan claim re-pointed
Claims processor
CLM-418487 → UHC-29960-66 (Julia Perkins)
Member id
UHC-29960-66
Confidence
1
Method
probabilistic
MBR-029198CLM-418487
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004647
Orphan claim re-pointed
Claims processor
CLM-412584 → UHC-95902-92 (Richard Simmons)
Member id
UHC-95902-92
Confidence
1
Method
probabilistic
MBR-007413CLM-412584
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004648
Orphan claim re-pointed
Claims processor
CLM-406572 → UHC-69881-24 (Jean Ward)
Member id
UHC-69881-24
Confidence
0.97
Method
deterministic
MBR-028505CLM-406572
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004649
Orphan claim re-pointed
Claims processor
CLM-413507 → UHC-05207-17 (Scott Fuller)
Member id
UHC-05207-17
Confidence
1
Method
probabilistic
MBR-028832CLM-413507
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004650
Orphan claim re-pointed
Claims processor
CLM-431068 → UHC-71496-81 (Aleexander Reed)
Member id
UHC-71496-81
Confidence
0.97
Method
deterministic
MBR-003671CLM-431068
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004651
Orphan claim re-pointed
Claims processor
CLM-416192 → UHC-72425-74 (Steven Brooks)
Member id
UHC-72425-74
Confidence
1
Method
probabilistic
MBR-020386CLM-416192
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004652
Orphan claim re-pointed
Claims processor
CLM-401601 → UHC-20395-46 (Michelle Greene)
Member id
UHC-20395-46
Confidence
1
Method
probabilistic
MBR-016634CLM-401601
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004653
Orphan claim re-pointed
Claims processor
CLM-410565 → UHC-15160-88 (Sean Silva)
Member id
UHC-15160-88
Confidence
0.97
Method
deterministic
MBR-017193CLM-410565
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004654
Orphan claim re-pointed
Claims processor
CLM-402140 → UHC-32734-85 (Bruce Johnston)
Member id
UHC-32734-85
Confidence
0.87
Method
probabilistic
MBR-008126CLM-402140
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004655
Orphan claim re-pointed
Claims processor
CLM-421164 → UHC-52984-88 (Bradley Foster)
Member id
UHC-52984-88
Confidence
1
Method
probabilistic
MBR-015421CLM-421164
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004656
Orphan claim re-pointed
Claims processor
CLM-421849 → UHC-40826-72 (Charles Fuller)
Member id
UHC-40826-72
Confidence
1
Method
probabilistic
MBR-021049CLM-421849
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004657
Orphan claim re-pointed
Claims processor
CLM-418328 → UHC-29058-11 (Hannah Willis)
Member id
UHC-29058-11
Confidence
1
Method
probabilistic
MBR-000099CLM-418328
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004658
Orphan claim re-pointed
Claims processor
CLM-405819 → UHC-02231-81 (Justin Hawkins)
Member id
UHC-02231-81
Confidence
1
Method
probabilistic
MBR-009426CLM-405819
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004659
Orphan claim re-pointed
Claims processor
CLM-410698 → UHC-84467-90 (Brandon Armstrong)
Member id
UHC-84467-90
Confidence
1
Method
probabilistic
MBR-016950CLM-410698
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004660
Orphan claim re-pointed
Claims processor
CLM-408257 → UHC-44075-82 (Wayne Franklin)
Member id
UHC-44075-82
Confidence
1
Method
probabilistic
MBR-014945CLM-408257
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004661
Orphan claim re-pointed
Claims processor
CLM-420320 → UHC-80809-16 (Isabella Garza)
Member id
UHC-80809-16
Confidence
0.98
Method
probabilistic
MBR-001442CLM-420320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004662
Orphan claim re-pointed
Claims processor
CLM-407857 → UHC-88715-46 (Ronald Espinoza)
Member id
UHC-88715-46
Confidence
1
Method
probabilistic
MBR-002670CLM-407857
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004663
Orphan claim re-pointed
Claims processor
CLM-428049 → UHC-03263-23 (Evelyn Black)
Member id
UHC-03263-23
Confidence
0.97
Method
deterministic
MBR-009885CLM-428049
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004664
Orphan claim re-pointed
Claims processor
CLM-417001 → UHC-38087-84 (Daniel Jimenez)
Member id
UHC-38087-84
Confidence
1
Method
probabilistic
MBR-007268CLM-417001
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004665
Orphan claim re-pointed
Claims processor
CLM-401823 → UHC-19090-03 (Cynthia Nelson)
Member id
UHC-19090-03
Confidence
1
Method
probabilistic
MBR-011202CLM-401823
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004666
Orphan claim re-pointed
Claims processor
CLM-400703 → UHC-32789-06 (Ethan Vargas)
Member id
UHC-32789-06
Confidence
1
Method
probabilistic
MBR-032275CLM-400703
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004667
Orphan claim re-pointed
Claims processor
CLM-427711 → UHC-66153-39 (Carol Brooks)
Member id
UHC-66153-39
Confidence
1
Method
probabilistic
MBR-026850CLM-427711
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004668
Orphan claim re-pointed
Claims processor
CLM-423228 → UHC-33176-99 (Joyce Evans)
Member id
UHC-33176-99
Confidence
1
Method
probabilistic
MBR-002437CLM-423228
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004669
Orphan claim re-pointed
Claims processor
CLM-411104 → UHC-05848-56 (Hannah Silva)
Member id
UHC-05848-56
Confidence
0.99
Method
probabilistic
MBR-011594CLM-411104
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004670
Orphan claim re-pointed
Claims processor
CLM-410562 → UHC-78828-86 (Kyle Olson)
Member id
UHC-78828-86
Confidence
0.99
Method
probabilistic
MBR-034845CLM-410562
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004671
Orphan claim re-pointed
Claims processor
CLM-418963 → UHC-23434-82 (Yuki Boyd)
Member id
UHC-23434-82
Confidence
1
Method
probabilistic
MBR-017319CLM-418963
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004672
Orphan claim re-pointed
Claims processor
CLM-430320 → UHC-98462-27 (Joyce Santos)
Member id
UHC-98462-27
Confidence
1
Method
probabilistic
MBR-008814CLM-430320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004673
Orphan claim re-pointed
Claims processor
CLM-412091 → UHC-37396-05 (Judith Stephens)
Member id
UHC-37396-05
Confidence
1
Method
probabilistic
MBR-035686CLM-412091
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004674
Orphan claim re-pointed
Claims processor
CLM-400320 → UHC-81351-96 (Edward Wilson)
Member id
UHC-81351-96
Confidence
1
Method
probabilistic
MBR-019938CLM-400320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004675
Orphan claim re-pointed
Claims processor
CLM-424374 → UHC-86900-82 (Bowman Bowman)
Member id
UHC-86900-82
Confidence
0.93
Method
probabilistic
MBR-005470CLM-424374
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004676
Orphan claim re-pointed
Claims processor
CLM-400939 → UHC-11754-69 (Roger Clark)
Member id
UHC-11754-69
Confidence
0.97
Method
deterministic
MBR-000715CLM-400939
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004677
Orphan claim re-pointed
Claims processor
CLM-406554 → UHC-78882-43 (Evelyn Green)
Member id
UHC-78882-43
Confidence
0.97
Method
deterministic
MBR-013508CLM-406554
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004678
Orphan claim re-pointed
Claims processor
CLM-401133 → UHC-91989-12 (Diana Dean)
Member id
UHC-91989-12
Confidence
0.97
Method
probabilistic
MBR-017083CLM-401133
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004679
Orphan claim re-pointed
Claims processor
CLM-431330 → UHC-60495-13 (Harold Nichols)
Member id
UHC-60495-13
Confidence
1
Method
probabilistic
MBR-003887CLM-431330
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004680
Orphan claim re-pointed
Claims processor
CLM-403036 → UHC-60766-67 (Patricia Ray)
Member id
UHC-60766-67
Confidence
0.97
Method
deterministic
MBR-019456CLM-403036
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004681
Orphan claim re-pointed
Claims processor
CLM-401112 → UHC-20583-29 (Jeff Garrett)
Member id
UHC-20583-29
Confidence
1
Method
probabilistic
MBR-035275CLM-401112
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004682
Orphan claim re-pointed
Claims processor
CLM-417152 → UHC-78337-47 (Timothy Wong)
Member id
UHC-78337-47
Confidence
1
Method
probabilistic
MBR-012430CLM-417152
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004683
Orphan claim re-pointed
Claims processor
CLM-407243 → UHC-87494-19 (Vincent Johnston)
Member id
UHC-87494-19
Confidence
1
Method
probabilistic
MBR-012560CLM-407243
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004684
Orphan claim re-pointed
Claims processor
CLM-404154 → UHC-47212-39 (Olivia Fox)
Member id
UHC-47212-39
Confidence
1
Method
probabilistic
MBR-002821CLM-404154
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004685
Orphan claim re-pointed
Claims processor
CLM-404416 → UHC-34937-60 (Alan Torres)
Member id
UHC-34937-60
Confidence
1
Method
probabilistic
MBR-027209CLM-404416
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004686
Orphan claim re-pointed
Claims processor
CLM-429651 → UHC-97105-20 (Timothy Ward)
Member id
UHC-97105-20
Confidence
0.97
Method
deterministic
MBR-030939CLM-429651
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004687
Orphan claim re-pointed
Claims processor
CLM-425914 → UHC-60558-56 (Ruth Ross)
Member id
UHC-60558-56
Confidence
1
Method
probabilistic
MBR-001545CLM-425914
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004688
Orphan claim re-pointed
Claims processor
CLM-414860 → UHC-90304-33 (Nancy Rojas)
Member id
UHC-90304-33
Confidence
1
Method
probabilistic
MBR-011210CLM-414860
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004689
Orphan claim re-pointed
Claims processor
CLM-414830 → UHC-12213-45 (Grace Coleman)
Member id
UHC-12213-45
Confidence
1
Method
probabilistic
MBR-021845CLM-414830
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 67 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.