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-004990
Orphan claim re-pointed
Claims processor
CLM-409063 → UHC-15058-92 (Gloria Murray)
Member id
UHC-15058-92
Confidence
0.93
Method
probabilistic
MBR-003311CLM-409063
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004991
Orphan claim re-pointed
Claims processor
CLM-408091 → UHC-11947-28 (Hiroshi Burns)
Member id
UHC-11947-28
Confidence
1
Method
probabilistic
MBR-010946CLM-408091
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004992
Orphan claim re-pointed
Claims processor
CLM-410576 → UHC-06958-21 (Larry Sanhez)
Member id
UHC-06958-21
Confidence
0.99
Method
probabilistic
MBR-035754CLM-410576
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004993
Orphan claim re-pointed
Claims processor
CLM-404822 → UHC-61173-72 (Michelle Gutierrez)
Member id
UHC-61173-72
Confidence
1
Method
probabilistic
MBR-023359CLM-404822
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004994
Orphan claim re-pointed
Claims processor
CLM-404567 → UHC-54937-30 (Grace Gardner)
Member id
UHC-54937-30
Confidence
1
Method
probabilistic
MBR-008620CLM-404567
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004995
Orphan claim re-pointed
Claims processor
CLM-402267 → UHC-87849-68 (Camila Snyder)
Member id
UHC-87849-68
Confidence
0.97
Method
deterministic
MBR-002012CLM-402267
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004996
Orphan claim re-pointed
Claims processor
CLM-426281 → UHC-83107-81 (Nathan Crawford)
Member id
UHC-83107-81
Confidence
1
Method
probabilistic
MBR-005000CLM-426281
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004997
Orphan claim re-pointed
Claims processor
CLM-401788 → UHC-47261-99 (Amanda Wallace)
Member id
UHC-47261-99
Confidence
0.97
Method
deterministic
MBR-000881CLM-401788
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004998
Orphan claim re-pointed
Claims processor
CLM-403825 → UHC-40594-68 (Scott Schultz)
Member id
UHC-40594-68
Confidence
1
Method
probabilistic
MBR-009986CLM-403825
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004999
Orphan claim re-pointed
Claims processor
CLM-415578 → UHC-47268-78 (Mark Jones)
Member id
UHC-47268-78
Confidence
1
Method
probabilistic
MBR-021819CLM-415578
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005000
Orphan claim re-pointed
Claims processor
CLM-404482 → UHC-68748-96 (Maria Fields)
Member id
UHC-68748-96
Confidence
1
Method
probabilistic
MBR-023403CLM-404482
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005001
Orphan claim re-pointed
Claims processor
CLM-401625 → UHC-99873-07 (Abigail Perkins)
Member id
UHC-99873-07
Confidence
1
Method
probabilistic
MBR-016343CLM-401625
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005002
Orphan claim re-pointed
Claims processor
CLM-431418 → UHC-90045-65 (Joan Elliott)
Member id
UHC-90045-65
Confidence
1
Method
probabilistic
MBR-016189CLM-431418
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005003
Orphan claim re-pointed
Claims processor
CLM-431860 → UHC-62190-94 (Randy Ross)
Member id
UHC-62190-94
Confidence
1
Method
probabilistic
MBR-014497CLM-431860
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005004
Orphan claim re-pointed
Claims processor
CLM-426199 → UHC-20056-04 (Cheryl Padilla)
Member id
UHC-20056-04
Confidence
0.97
Method
deterministic
MBR-018839CLM-426199
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005005
Orphan claim re-pointed
Claims processor
CLM-425256 → UHC-36645-75 (Sophia Hunt)
Member id
UHC-36645-75
Confidence
1
Method
probabilistic
MBR-005512CLM-425256
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005006
Orphan claim re-pointed
Claims processor
CLM-429941 → UHC-58486-46 (Patrick Sanders)
Member id
UHC-58486-46
Confidence
1
Method
probabilistic
MBR-008595CLM-429941
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005007
Orphan claim re-pointed
Claims processor
CLM-417438 → UHC-96426-29 (Samuel Rodriguez)
Member id
UHC-96426-29
Confidence
1
Method
probabilistic
MBR-023428CLM-417438
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005008
Orphan claim re-pointed
Claims processor
CLM-422476 → UHC-02124-02 (Ryan Fox)
Member id
UHC-02124-02
Confidence
0.85
Method
probabilistic
MBR-021449CLM-422476
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005009
Orphan claim re-pointed
Claims processor
CLM-432510 → UHC-09172-06 (Susan Perez)
Member id
UHC-09172-06
Confidence
1
Method
probabilistic
MBR-021307CLM-432510
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005010
Orphan claim re-pointed
Claims processor
CLM-428393 → UHC-18772-45 (Aaron Gonzalez)
Member id
UHC-18772-45
Confidence
1
Method
probabilistic
MBR-016784CLM-428393
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005011
Orphan claim re-pointed
Claims processor
CLM-402290 → UHC-69231-03 (Anna Young)
Member id
UHC-69231-03
Confidence
1
Method
probabilistic
MBR-039840CLM-402290
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005012
Orphan claim re-pointed
Claims processor
CLM-401363 → UHC-19223-34 (Cheryl Chen)
Member id
UHC-19223-34
Confidence
1
Method
probabilistic
MBR-013451CLM-401363
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005013
Orphan claim re-pointed
Claims processor
CLM-428878 → UHC-30320-78 (Judy Murray)
Member id
UHC-30320-78
Confidence
0.99
Method
probabilistic
MBR-001849CLM-428878
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005014
Orphan claim re-pointed
Claims processor
CLM-412157 → UHC-81661-07 (Michelle Hayes)
Member id
UHC-81661-07
Confidence
0.99
Method
probabilistic
MBR-036548CLM-412157
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005015
Orphan claim re-pointed
Claims processor
CLM-419690 → UHC-99443-53 (Charles Ray)
Member id
UHC-99443-53
Confidence
0.97
Method
deterministic
MBR-012776CLM-419690
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005016
Orphan claim re-pointed
Claims processor
CLM-423093 → UHC-66987-31 (Olivia Cooper)
Member id
UHC-66987-31
Confidence
1
Method
probabilistic
MBR-002290CLM-423093
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005017
Orphan claim re-pointed
Claims processor
CLM-415972 → UHC-83367-14 (Peter Padilla)
Member id
UHC-83367-14
Confidence
0.97
Method
deterministic
MBR-009342CLM-415972
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005018
Orphan claim re-pointed
Claims processor
CLM-428415 → UHC-65934-13 (Nicholas Santos)
Member id
UHC-65934-13
Confidence
1
Method
probabilistic
MBR-001937CLM-428415
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005019
Orphan claim re-pointed
Claims processor
CLM-425241 → UHC-25986-60 (Carol Weber)
Member id
UHC-25986-60
Confidence
0.99
Method
probabilistic
MBR-039592CLM-425241
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005020
Orphan claim re-pointed
Claims processor
CLM-407105 → UHC-63140-98 (Emma Harrison)
Member id
UHC-63140-98
Confidence
0.99
Method
probabilistic
MBR-020063CLM-407105
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005021
Orphan claim re-pointed
Claims processor
CLM-431658 → UHC-98030-27 (Billy Fisher)
Member id
UHC-98030-27
Confidence
1
Method
probabilistic
MBR-004925CLM-431658
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005022
Orphan claim re-pointed
Claims processor
CLM-417911 → UHC-56078-78 (Christina Hernandez)
Member id
UHC-56078-78
Confidence
0.97
Method
deterministic
MBR-014678CLM-417911
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005023
Orphan claim re-pointed
Claims processor
CLM-416385 → UHC-48980-78 (Laura Perez)
Member id
UHC-48980-78
Confidence
0.99
Method
probabilistic
MBR-020626CLM-416385
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005024
Orphan claim re-pointed
Claims processor
CLM-408582 → UHC-52339-52 (Steven Burns)
Member id
UHC-52339-52
Confidence
0.97
Method
deterministic
MBR-023290CLM-408582
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005025
Orphan claim re-pointed
Claims processor
CLM-406395 → UHC-17083-49 (Judith Collins)
Member id
UHC-17083-49
Confidence
0.97
Method
deterministic
MBR-037389CLM-406395
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005026
Orphan claim re-pointed
Claims processor
CLM-413714 → UHC-92123-72 (Samantha Diaz)
Member id
UHC-92123-72
Confidence
1
Method
probabilistic
MBR-011493CLM-413714
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005027
Orphan claim re-pointed
Claims processor
CLM-402364 → UHC-44962-11 (Peter Vazquez)
Member id
UHC-44962-11
Confidence
1
Method
probabilistic
MBR-029596CLM-402364
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005028
Orphan claim re-pointed
Claims processor
CLM-424368 → UHC-06095-01 (Billy Burns)
Member id
UHC-06095-01
Confidence
1
Method
probabilistic
MBR-027815CLM-424368
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005029
Orphan claim re-pointed
Claims processor
CLM-429943 → UHC-58486-46 (Patrick Sanders)
Member id
UHC-58486-46
Confidence
1
Method
probabilistic
MBR-008595CLM-429943
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005030
Orphan claim re-pointed
Claims processor
CLM-430910 → UHC-86460-92 (Theresa Lewiis)
Member id
UHC-86460-92
Confidence
0.99
Method
probabilistic
MBR-007580CLM-430910
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005031
Orphan claim re-pointed
Claims processor
CLM-427600 → UHC-27057-19 (Timothy Rios)
Member id
UHC-27057-19
Confidence
1
Method
probabilistic
MBR-005726CLM-427600
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005032
Orphan claim re-pointed
Claims processor
CLM-415963 → UHC-65136-03 (Kelly Contreras)
Member id
UHC-65136-03
Confidence
1
Method
probabilistic
MBR-019716CLM-415963
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005033
Orphan claim re-pointed
Claims processor
CLM-419164 → UHC-46535-81 (Anthony Wells)
Member id
UHC-46535-81
Confidence
1
Method
probabilistic
MBR-006606CLM-419164
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005034
Orphan claim re-pointed
Claims processor
CLM-400074 → UHC-66377-79 (Joseph Williamson)
Member id
UHC-66377-79
Confidence
0.97
Method
deterministic
MBR-038094CLM-400074
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005035
Orphan claim re-pointed
Claims processor
CLM-400182 → UHC-59123-12 (Larry Chapman)
Member id
UHC-59123-12
Confidence
1
Method
probabilistic
MBR-026601CLM-400182
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005036
Orphan claim re-pointed
Claims processor
CLM-419158 → UHC-72128-31 (Janice McCoy)
Member id
UHC-72128-31
Confidence
0.99
Method
probabilistic
MBR-023818CLM-419158
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005037
Orphan claim re-pointed
Claims processor
CLM-405426 → UHC-48728-33 (Sara Patel)
Member id
UHC-48728-33
Confidence
1
Method
probabilistic
MBR-039514CLM-405426
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005038
Orphan claim re-pointed
Claims processor
CLM-404776 → UHC-02464-83 (Maria Ray)
Member id
UHC-02464-83
Confidence
1
Method
probabilistic
MBR-026842CLM-404776
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005039
Orphan claim re-pointed
Claims processor
CLM-402428 → UHC-30142-52 (James Chen)
Member id
UHC-30142-52
Confidence
1
Method
probabilistic
MBR-004961CLM-402428
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 74 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.