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-005440
Orphan claim re-pointed
Claims processor
CLM-426066 → UHC-91411-90 (Charles Tucker)
Member id
UHC-91411-90
Confidence
0.97
Method
deterministic
MBR-015395CLM-426066
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005441
Orphan claim re-pointed
Claims processor
CLM-424254 → UHC-36916-85 (Beverly Butler)
Member id
UHC-36916-85
Confidence
1
Method
probabilistic
MBR-016459CLM-424254
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005442
Orphan claim re-pointed
Claims processor
CLM-412958 → UHC-47131-54 (Dylan Ross)
Member id
UHC-47131-54
Confidence
1
Method
probabilistic
MBR-011651CLM-412958
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005443
Orphan claim re-pointed
Claims processor
CLM-419817 → UHC-77204-58 (Doris Elliott)
Member id
UHC-77204-58
Confidence
1
Method
probabilistic
MBR-024511CLM-419817
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005444
Orphan claim re-pointed
Claims processor
CLM-427818 → UHC-77908-77 (Camila Gibson)
Member id
UHC-77908-77
Confidence
1
Method
probabilistic
MBR-028550CLM-427818
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005445
Orphan claim re-pointed
Claims processor
CLM-403277 → UHC-17614-53 (Harold Cox)
Member id
UHC-17614-53
Confidence
0.97
Method
deterministic
MBR-020305CLM-403277
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005446
Orphan claim re-pointed
Claims processor
CLM-415483 → UHC-25673-02 (Diego Schmidt)
Member id
UHC-25673-02
Confidence
0.97
Method
deterministic
MBR-032682CLM-415483
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005447
Orphan claim re-pointed
Claims processor
CLM-421544 → UHC-22001-33 (Megan Medina)
Member id
UHC-22001-33
Confidence
1
Method
probabilistic
MBR-007595CLM-421544
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005448
Orphan claim re-pointed
Claims processor
CLM-414200 → UHC-77438-22 (Mari Larson)
Member id
UHC-77438-22
Confidence
0.97
Method
deterministic
MBR-012173CLM-414200
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005449
Orphan claim re-pointed
Claims processor
CLM-432416 → UHC-35325-16 (Jacob Rojas)
Member id
UHC-35325-16
Confidence
1
Method
probabilistic
MBR-005888CLM-432416
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005450
Orphan claim re-pointed
Claims processor
CLM-410078 → UHC-03599-81 (Lisa Munoz)
Member id
UHC-03599-81
Confidence
0.97
Method
deterministic
MBR-042247CLM-410078
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005451
Orphan claim re-pointed
Claims processor
CLM-413945 → UHC-34110-11 (Mason Rios)
Member id
UHC-34110-11
Confidence
1
Method
probabilistic
MBR-020572CLM-413945
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005452
Orphan claim re-pointed
Claims processor
CLM-411844 → UHC-86550-30 (Patrick Le)
Member id
UHC-86550-30
Confidence
0.97
Method
deterministic
MBR-020318CLM-411844
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005453
Orphan claim re-pointed
Claims processor
CLM-403018 → UHC-61543-39 (Nancy Vazquez)
Member id
UHC-61543-39
Confidence
1
Method
probabilistic
MBR-008493CLM-403018
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005454
Orphan claim re-pointed
Claims processor
CLM-419287 → UHC-90566-07 (Marilyn Carr)
Member id
UHC-90566-07
Confidence
1
Method
probabilistic
MBR-031875CLM-419287
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005455
Orphan claim re-pointed
Claims processor
CLM-400129 → UHC-57472-02 (William Dean)
Member id
UHC-57472-02
Confidence
1
Method
probabilistic
MBR-004221CLM-400129
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005456
Orphan claim re-pointed
Claims processor
CLM-410846 → UHC-45064-52 (Laura Powell)
Member id
UHC-45064-52
Confidence
0.97
Method
deterministic
MBR-017116CLM-410846
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005457
Orphan claim re-pointed
Claims processor
CLM-413841 → UHC-77457-34 (Austin Nelson)
Member id
UHC-77457-34
Confidence
1
Method
probabilistic
MBR-027126CLM-413841
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005458
Orphan claim re-pointed
Claims processor
CLM-400201 → UHC-26091-54 (Roger Ortiz)
Member id
UHC-26091-54
Confidence
0.97
Method
deterministic
MBR-021103CLM-400201
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005459
Orphan claim re-pointed
Claims processor
CLM-411083 → UHC-73884-55 (Gabriel Harrison)
Member id
UHC-73884-55
Confidence
0.93
Method
probabilistic
MBR-030658CLM-411083
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005460
Orphan claim re-pointed
Claims processor
CLM-424362 → UHC-15386-32 (Pamela Hayes)
Member id
UHC-15386-32
Confidence
1
Method
probabilistic
MBR-006716CLM-424362
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005461
Orphan claim re-pointed
Claims processor
CLM-412048 → UHC-59354-09 (Laryr Lawson)
Member id
UHC-59354-09
Confidence
0.99
Method
probabilistic
MBR-002946CLM-412048
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005462
Orphan claim re-pointed
Claims processor
CLM-418654 → UHC-62081-02 (Maria Gonzales)
Member id
UHC-62081-02
Confidence
1
Method
probabilistic
MBR-028770CLM-418654
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005463
Orphan claim re-pointed
Claims processor
CLM-408196 → UHC-56453-10 (Kelly Harris)
Member id
UHC-56453-10
Confidence
1
Method
probabilistic
MBR-006496CLM-408196
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005464
Orphan claim re-pointed
Claims processor
CLM-407113 → UHC-76710-68 (Katherine Hernandez)
Member id
UHC-76710-68
Confidence
1
Method
probabilistic
MBR-020169CLM-407113
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005465
Orphan claim re-pointed
Claims processor
CLM-419584 → UHC-23309-57 (Jesse Harrison)
Member id
UHC-23309-57
Confidence
1
Method
probabilistic
MBR-010825CLM-419584
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005466
Orphan claim re-pointed
Claims processor
CLM-418717 → UHC-31272-97 (Jason Watson)
Member id
UHC-31272-97
Confidence
0.99
Method
probabilistic
MBR-008031CLM-418717
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005467
Orphan claim re-pointed
Claims processor
CLM-423593 → UHC-72123-01 (Rebecca Rodriguez)
Member id
UHC-72123-01
Confidence
0.97
Method
deterministic
MBR-031557CLM-423593
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005468
Orphan claim re-pointed
Claims processor
CLM-400590 → UHC-96079-84 (Kathleen Le)
Member id
UHC-96079-84
Confidence
0.94
Method
probabilistic
MBR-016145CLM-400590
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005469
Orphan claim re-pointed
Claims processor
CLM-408476 → UHC-08239-66 (Eric Castro)
Member id
UHC-08239-66
Confidence
1
Method
probabilistic
MBR-004267CLM-408476
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005470
Orphan claim re-pointed
Claims processor
CLM-411460 → UHC-57349-54 (Carl Montgomery)
Member id
UHC-57349-54
Confidence
0.97
Method
deterministic
MBR-001048CLM-411460
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005471
Orphan claim re-pointed
Claims processor
CLM-408820 → UHC-04938-33 (Zachary Hudson)
Member id
UHC-04938-33
Confidence
0.94
Method
probabilistic
MBR-027874CLM-408820
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005472
Orphan claim re-pointed
Claims processor
CLM-402221 → UHC-52893-38 (Kimberly Crawford)
Member id
UHC-52893-38
Confidence
1
Method
probabilistic
MBR-013089CLM-402221
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005473
Orphan claim re-pointed
Claims processor
CLM-430008 → UHC-97637-81 (Jacqueline Hansen)
Member id
UHC-97637-81
Confidence
1
Method
probabilistic
MBR-012321CLM-430008
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005474
Orphan claim re-pointed
Claims processor
CLM-408873 → UHC-71648-01 (Helen Washington)
Member id
UHC-71648-01
Confidence
0.97
Method
deterministic
MBR-016330CLM-408873
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005475
Orphan claim re-pointed
Claims processor
CLM-410617 → UHC-31632-29 (Ronald Sanders)
Member id
UHC-31632-29
Confidence
1
Method
probabilistic
MBR-015519CLM-410617
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005476
Orphan claim re-pointed
Claims processor
CLM-421773 → UHC-12314-12 (Luis McDonald)
Member id
UHC-12314-12
Confidence
1
Method
probabilistic
MBR-021746CLM-421773
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005477
Orphan claim re-pointed
Claims processor
CLM-407587 → UHC-32673-49 (Charles Thomas)
Member id
UHC-32673-49
Confidence
1
Method
probabilistic
MBR-008976CLM-407587
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005478
Orphan claim re-pointed
Claims processor
CLM-403401 → UHC-28801-38 (Amanda Cole)
Member id
UHC-28801-38
Confidence
1
Method
probabilistic
MBR-014968CLM-403401
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005479
Orphan claim re-pointed
Claims processor
CLM-420749 → UHC-72641-27 (Laura Little)
Member id
UHC-72641-27
Confidence
1
Method
probabilistic
MBR-033248CLM-420749
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005480
Orphan claim re-pointed
Claims processor
CLM-424622 → UHC-01081-09 (Jack Austin)
Member id
UHC-01081-09
Confidence
1
Method
probabilistic
MBR-002844CLM-424622
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005481
Orphan claim re-pointed
Claims processor
CLM-431152 → UHC-45378-23 (Jordan Munoz)
Member id
UHC-45378-23
Confidence
1
Method
probabilistic
MBR-033727CLM-431152
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005482
Orphan claim re-pointed
Claims processor
CLM-429476 → UHC-65430-50 (Megan Mejia)
Member id
UHC-65430-50
Confidence
1
Method
probabilistic
MBR-024441CLM-429476
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005483
Orphan claim re-pointed
Claims processor
CLM-400379 → UHC-39117-66 (Vicky Lynch)
Member id
UHC-39117-66
Confidence
0.97
Method
deterministic
MBR-030704CLM-400379
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005484
Orphan claim re-pointed
Claims processor
CLM-406645 → UHC-24696-32 (Denise King)
Member id
UHC-24696-32
Confidence
1
Method
probabilistic
MBR-019913CLM-406645
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005485
Orphan claim re-pointed
Claims processor
CLM-413941 → UHC-01330-32 (Albert Marshall)
Member id
UHC-01330-32
Confidence
0.99
Method
probabilistic
MBR-023427CLM-413941
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005486
Orphan claim re-pointed
Claims processor
CLM-411994 → UHC-06277-65 (Maria Hoffman)
Member id
UHC-06277-65
Confidence
0.99
Method
probabilistic
MBR-004747CLM-411994
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005487
Orphan claim re-pointed
Claims processor
CLM-410052 → UHC-88337-04 (Peter Myers)
Member id
UHC-88337-04
Confidence
1
Method
probabilistic
MBR-017997CLM-410052
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005488
Orphan claim re-pointed
Claims processor
CLM-423406 → UHC-89016-23 (Philip Arnold)
Member id
UHC-89016-23
Confidence
1
Method
probabilistic
MBR-027666CLM-423406
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005489
Orphan claim re-pointed
Claims processor
CLM-416932 → UHC-57453-86 (Stephen Stevens)
Member id
UHC-57453-86
Confidence
0.97
Method
deterministic
MBR-005676CLM-416932
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 83 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.