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-001640
Orphan claim re-pointed
Claims processor
CLM-409991 → UHC-44921-94 (Mark Washington)
Member id
UHC-44921-94
Confidence
1
Method
probabilistic
MBR-000578CLM-409991
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001641
Orphan claim re-pointed
Claims processor
CLM-427622 → UHC-71503-66 (Jose Bradley)
Member id
UHC-71503-66
Confidence
0.97
Method
deterministic
MBR-002461CLM-427622
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001642
Orphan claim re-pointed
Claims processor
CLM-413823 → UHC-28890-43 (Madison Jenkins)
Member id
UHC-28890-43
Confidence
1
Method
probabilistic
MBR-040823CLM-413823
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001643
Orphan claim re-pointed
Claims processor
CLM-430928 → UHC-71924-51 (Jason Meyer)
Member id
UHC-71924-51
Confidence
1
Method
probabilistic
MBR-013575CLM-430928
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001644
Orphan claim re-pointed
Claims processor
CLM-418000 → UHC-73816-85 (Hiroshi Little)
Member id
UHC-73816-85
Confidence
0.97
Method
deterministic
MBR-035620CLM-418000
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001645
Orphan claim re-pointed
Claims processor
CLM-410715 → UHC-43965-26 (Harold Nelson)
Member id
UHC-43965-26
Confidence
1
Method
probabilistic
MBR-020249CLM-410715
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001646
Orphan claim re-pointed
Claims processor
CLM-410694 → UHC-84665-74 (David Woods)
Member id
UHC-84665-74
Confidence
1
Method
probabilistic
MBR-001635CLM-410694
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001647
Orphan claim re-pointed
Claims processor
CLM-425818 → UHC-57021-61 (Christine Wagner)
Member id
UHC-57021-61
Confidence
1
Method
probabilistic
MBR-007869CLM-425818
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001648
Orphan claim re-pointed
Claims processor
CLM-419940 → UHC-33495-99 (Gloria Lee)
Member id
UHC-33495-99
Confidence
1
Method
probabilistic
MBR-005664CLM-419940
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001649
Orphan claim re-pointed
Claims processor
CLM-427386 → UHC-37162-88 (Mei Vasquez)
Member id
UHC-37162-88
Confidence
1
Method
probabilistic
MBR-030945CLM-427386
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001650
Orphan claim re-pointed
Claims processor
CLM-422730 → UHC-11971-67 (Benjamin Fuller)
Member id
UHC-11971-67
Confidence
1
Method
probabilistic
MBR-021063CLM-422730
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001651
Orphan claim re-pointed
Claims processor
CLM-430974 → UHC-90564-84 (Diane Olson)
Member id
UHC-90564-84
Confidence
1
Method
probabilistic
MBR-005647CLM-430974
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001652
Orphan claim re-pointed
Claims processor
CLM-402851 → UHC-16038-21 (Olivia Chapman)
Member id
UHC-16038-21
Confidence
0.97
Method
deterministic
MBR-002475CLM-402851
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001653
Orphan claim re-pointed
Claims processor
CLM-431941 → UHC-90646-41 (Diego Dominguez)
Member id
UHC-90646-41
Confidence
0.99
Method
probabilistic
MBR-026057CLM-431941
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001654
Orphan claim re-pointed
Claims processor
CLM-429681 → UHC-72843-98 (Cheryl Howell)
Member id
UHC-72843-98
Confidence
1
Method
probabilistic
MBR-001178CLM-429681
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001655
Orphan claim re-pointed
Claims processor
CLM-412884 → UHC-31359-39 (Cynthia Alvarez)
Member id
UHC-31359-39
Confidence
1
Method
probabilistic
MBR-037743CLM-412884
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001656
Orphan claim re-pointed
Claims processor
CLM-410307 → UHC-55904-11 (Helen Phillips)
Member id
UHC-55904-11
Confidence
0.97
Method
deterministic
MBR-028784CLM-410307
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001657
Orphan claim re-pointed
Claims processor
CLM-406675 → UHC-36379-12 (William Vasquez)
Member id
UHC-36379-12
Confidence
0.99
Method
probabilistic
MBR-025880CLM-406675
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001658
Orphan claim re-pointed
Claims processor
CLM-417144 → UHC-10960-04 (Anna Burke)
Member id
UHC-10960-04
Confidence
1
Method
probabilistic
MBR-018737CLM-417144
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001659
Orphan claim re-pointed
Claims processor
CLM-407266 → UHC-91645-03 (Julia George)
Member id
UHC-91645-03
Confidence
0.94
Method
probabilistic
MBR-038141CLM-407266
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001660
Orphan claim re-pointed
Claims processor
CLM-414396 → UHC-35055-55 (Santiago Miller)
Member id
UHC-35055-55
Confidence
1
Method
probabilistic
MBR-008038CLM-414396
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001661
Orphan claim re-pointed
Claims processor
CLM-404060 → UHC-71322-95 (Lauren Wong)
Member id
UHC-71322-95
Confidence
1
Method
probabilistic
MBR-002981CLM-404060
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001662
Orphan claim re-pointed
Claims processor
CLM-400475 → UHC-71028-83 (Robert Welch)
Member id
UHC-71028-83
Confidence
1
Method
probabilistic
MBR-006106CLM-400475
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001663
Orphan claim re-pointed
Claims processor
CLM-420437 → UHC-47088-25 (Ronald Ellis)
Member id
UHC-47088-25
Confidence
0.97
Method
deterministic
MBR-016763CLM-420437
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001664
Orphan claim re-pointed
Claims processor
CLM-426866 → UHC-68665-03 (Jordan Ferguson)
Member id
UHC-68665-03
Confidence
1
Method
probabilistic
MBR-018358CLM-426866
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001665
Orphan claim re-pointed
Claims processor
CLM-430822 → UHC-99271-57 (Kimberly Wang)
Member id
UHC-99271-57
Confidence
1
Method
probabilistic
MBR-028132CLM-430822
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001666
Orphan claim re-pointed
Claims processor
CLM-426923 → UHC-28733-52 (Sofia Gonzalez)
Member id
UHC-28733-52
Confidence
1
Method
probabilistic
MBR-001440CLM-426923
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001667
Orphan claim re-pointed
Claims processor
CLM-430691 → UHC-69584-36 (Jose Harvey)
Member id
UHC-69584-36
Confidence
1
Method
probabilistic
MBR-035932CLM-430691
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001668
Orphan claim re-pointed
Claims processor
CLM-401190 → UHC-19534-62 (Sofia Yang)
Member id
UHC-19534-62
Confidence
1
Method
probabilistic
MBR-007443CLM-401190
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001669
Orphan claim re-pointed
Claims processor
CLM-400995 → UHC-15801-99 (Jason Garrett)
Member id
UHC-15801-99
Confidence
1
Method
probabilistic
MBR-010493CLM-400995
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001670
Orphan claim re-pointed
Claims processor
CLM-414647 → UHC-46520-40 (Santiago Wong)
Member id
UHC-46520-40
Confidence
0.97
Method
deterministic
MBR-013102CLM-414647
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001671
Orphan claim re-pointed
Claims processor
CLM-429106 → UHC-77898-36 (Anna Murphy)
Member id
UHC-77898-36
Confidence
1
Method
probabilistic
MBR-027298CLM-429106
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001672
Orphan claim re-pointed
Claims processor
CLM-406959 → UHC-06730-30 (Joe Carlson)
Member id
UHC-06730-30
Confidence
0.97
Method
deterministic
MBR-039586CLM-406959
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001673
Orphan claim re-pointed
Claims processor
CLM-431059 → UHC-20299-86 (Jonathan Hunt)
Member id
UHC-20299-86
Confidence
1
Method
probabilistic
MBR-008072CLM-431059
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001674
Orphan claim re-pointed
Claims processor
CLM-420049 → UHC-35222-28 (Alan Pierce)
Member id
UHC-35222-28
Confidence
1
Method
probabilistic
MBR-013887CLM-420049
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001675
Orphan claim re-pointed
Claims processor
CLM-424160 → UHC-17028-42 (Randy Maldonado)
Member id
UHC-17028-42
Confidence
0.99
Method
probabilistic
MBR-019240CLM-424160
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001676
Orphan claim re-pointed
Claims processor
CLM-401783 → UHC-66150-22 (Amy Rice)
Member id
UHC-66150-22
Confidence
0.97
Method
deterministic
MBR-026347CLM-401783
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001677
Orphan claim re-pointed
Claims processor
CLM-415621 → UHC-28164-13 (Ana Walker)
Member id
UHC-28164-13
Confidence
0.97
Method
deterministic
MBR-009654CLM-415621
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001678
Orphan claim re-pointed
Claims processor
CLM-411068 → UHC-70614-01 (Beverly Ryan)
Member id
UHC-70614-01
Confidence
0.97
Method
deterministic
MBR-032871CLM-411068
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001679
Orphan claim re-pointed
Claims processor
CLM-411809 → UHC-83880-59 (Gary Hamilton)
Member id
UHC-83880-59
Confidence
1
Method
probabilistic
MBR-029620CLM-411809
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001680
Orphan claim re-pointed
Claims processor
CLM-431690 → UHC-71794-17 (Jacqueline Richards)
Member id
UHC-71794-17
Confidence
1
Method
probabilistic
MBR-002078CLM-431690
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001681
Orphan claim re-pointed
Claims processor
CLM-430466 → UHC-96542-58 (Joyce Sanders)
Member id
UHC-96542-58
Confidence
0.99
Method
probabilistic
MBR-020368CLM-430466
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001682
Orphan claim re-pointed
Claims processor
CLM-401628 → UHC-49778-27 (Cheryl Arnold)
Member id
UHC-49778-27
Confidence
1
Method
probabilistic
MBR-004892CLM-401628
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001683
Orphan claim re-pointed
Claims processor
CLM-400397 → UHC-89598-42 (Douglas Reyes)
Member id
UHC-89598-42
Confidence
1
Method
probabilistic
MBR-029149CLM-400397
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001684
Orphan claim re-pointed
Claims processor
CLM-420427 → UHC-18931-33 (Thomas Carter)
Member id
UHC-18931-33
Confidence
0.97
Method
deterministic
MBR-005273CLM-420427
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001685
Orphan claim re-pointed
Claims processor
CLM-427051 → UHC-14951-40 (Isabella Singh)
Member id
UHC-14951-40
Confidence
1
Method
probabilistic
MBR-028304CLM-427051
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001686
Orphan claim re-pointed
Claims processor
CLM-418982 → UHC-50033-62 (Gary Jordan)
Member id
UHC-50033-62
Confidence
1
Method
probabilistic
MBR-007801CLM-418982
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001687
Orphan claim re-pointed
Claims processor
CLM-431503 → UHC-12386-49 (Martha Harvey)
Member id
UHC-12386-49
Confidence
1
Method
probabilistic
MBR-004236CLM-431503
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001688
Orphan claim re-pointed
Claims processor
CLM-407638 → UHC-43455-67 (Ana Mason)
Member id
UHC-43455-67
Confidence
1
Method
probabilistic
MBR-006128CLM-407638
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001689
Orphan claim re-pointed
Claims processor
CLM-432237 → UHC-42112-04 (Carl West)
Member id
UHC-42112-04
Confidence
1
Method
probabilistic
MBR-025601CLM-432237
Executed
resolution_agent
2026-10-19 19:54:39
9,112 rows, page 7 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.