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-005790
Orphan claim re-pointed
Claims processor
CLM-431323 → UHC-46514-85 (Jack Jordan)
Member id
UHC-46514-85
Confidence
0.91
Method
probabilistic
MBR-013408CLM-431323
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005791
Orphan claim re-pointed
Claims processor
CLM-409571 → UHC-33464-88 (Harold Mason)
Member id
UHC-33464-88
Confidence
1
Method
probabilistic
MBR-003623CLM-409571
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005792
Orphan claim re-pointed
Claims processor
CLM-412431 → UHC-41836-57 (Willie Hansen)
Member id
UHC-41836-57
Confidence
1
Method
probabilistic
MBR-029465CLM-412431
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005793
Orphan claim re-pointed
Claims processor
CLM-403611 → UHC-10594-91 (Joseph Cunningham)
Member id
UHC-10594-91
Confidence
1
Method
probabilistic
MBR-009256CLM-403611
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005794
Orphan claim re-pointed
Claims processor
CLM-416142 → UHC-61680-99 (Karen Cook)
Member id
UHC-61680-99
Confidence
1
Method
probabilistic
MBR-006874CLM-416142
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005795
Orphan claim re-pointed
Claims processor
CLM-400237 → UHC-96990-15 (Angela Espinoza)
Member id
UHC-96990-15
Confidence
0.99
Method
probabilistic
MBR-017663CLM-400237
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005796
Orphan claim re-pointed
Claims processor
CLM-425893 → UHC-32653-89 (Maria Freeman)
Member id
UHC-32653-89
Confidence
1
Method
probabilistic
MBR-000706CLM-425893
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005797
Orphan claim re-pointed
Claims processor
CLM-425717 → UHC-20504-81 (Teresa Fisher)
Member id
UHC-20504-81
Confidence
0.99
Method
probabilistic
MBR-009576CLM-425717
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005798
Orphan claim re-pointed
Claims processor
CLM-427378 → UHC-30457-09 (Roger Davis)
Member id
UHC-30457-09
Confidence
1
Method
probabilistic
MBR-010102CLM-427378
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005799
Orphan claim re-pointed
Claims processor
CLM-405041 → UHC-78535-38 (Judy Sanders)
Member id
UHC-78535-38
Confidence
1
Method
probabilistic
MBR-024997CLM-405041
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005800
Orphan claim re-pointed
Claims processor
CLM-401206 → UHC-20620-59 (Katherine Carpenter)
Member id
UHC-20620-59
Confidence
1
Method
probabilistic
MBR-006438CLM-401206
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005801
Orphan claim re-pointed
Claims processor
CLM-407617 → UHC-79313-90 (Patricia Schultz)
Member id
UHC-79313-90
Confidence
1
Method
probabilistic
MBR-025847CLM-407617
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005802
Orphan claim re-pointed
Claims processor
CLM-412968 → UHC-20449-42 (Janice Hunt)
Member id
UHC-20449-42
Confidence
1
Method
probabilistic
MBR-021671CLM-412968
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005803
Orphan claim re-pointed
Claims processor
CLM-401425 → UHC-69979-70 (Maria Singh)
Member id
UHC-69979-70
Confidence
0.98
Method
probabilistic
MBR-018695CLM-401425
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005804
Orphan claim re-pointed
Claims processor
CLM-410430 → UHC-36655-13 (Anna Dunn)
Member id
UHC-36655-13
Confidence
1
Method
probabilistic
MBR-015284CLM-410430
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005805
Orphan claim re-pointed
Claims processor
CLM-429432 → UHC-83381-43 (Mason Taylor)
Member id
UHC-83381-43
Confidence
1
Method
probabilistic
MBR-019125CLM-429432
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005806
Orphan claim re-pointed
Claims processor
CLM-419003 → UHC-78943-88 (Rachel Green)
Member id
UHC-78943-88
Confidence
0.97
Method
deterministic
MBR-025662CLM-419003
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005807
Orphan claim re-pointed
Claims processor
CLM-426478 → UHC-23750-61 (Bryan Matthews)
Member id
UHC-23750-61
Confidence
1
Method
probabilistic
MBR-017637CLM-426478
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005808
Orphan claim re-pointed
Claims processor
CLM-411775 → UHC-64477-90 (Eric Elliott)
Member id
UHC-64477-90
Confidence
1
Method
probabilistic
MBR-004617CLM-411775
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005809
Orphan claim re-pointed
Claims processor
CLM-402188 → UHC-07177-15 (Theresa West)
Member id
UHC-07177-15
Confidence
0.97
Method
deterministic
MBR-003519CLM-402188
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005810
Orphan claim re-pointed
Claims processor
CLM-404895 → UHC-67650-36 (Wei Harrison)
Member id
UHC-67650-36
Confidence
1
Method
probabilistic
MBR-014493CLM-404895
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005811
Orphan claim re-pointed
Claims processor
CLM-419704 → UHC-19883-88 (Gabriel Thompson)
Member id
UHC-19883-88
Confidence
1
Method
probabilistic
MBR-010009CLM-419704
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005812
Orphan claim re-pointed
Claims processor
CLM-423458 → UHC-15734-55 (Patricia Cooper)
Member id
UHC-15734-55
Confidence
1
Method
probabilistic
MBR-007189CLM-423458
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005813
Orphan claim re-pointed
Claims processor
CLM-423803 → UHC-46530-32 (Frank Parker)
Member id
UHC-46530-32
Confidence
0.92
Method
probabilistic
MBR-017919CLM-423803
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005814
Orphan claim re-pointed
Claims processor
CLM-401267 → UHC-49602-83 (Diego Woods)
Member id
UHC-49602-83
Confidence
1
Method
probabilistic
MBR-027391CLM-401267
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005815
Orphan claim re-pointed
Claims processor
CLM-404824 → UHC-23811-98 (Heather Myers)
Member id
UHC-23811-98
Confidence
1
Method
probabilistic
MBR-008860CLM-404824
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005816
Orphan claim re-pointed
Claims processor
CLM-421054 → UHC-98893-34 (Dennis Sims)
Member id
UHC-98893-34
Confidence
1
Method
probabilistic
MBR-015754CLM-421054
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005817
Orphan claim re-pointed
Claims processor
CLM-416338 → UHC-88907-28 (Albert Daniels)
Member id
UHC-88907-28
Confidence
1
Method
probabilistic
MBR-016082CLM-416338
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005818
Orphan claim re-pointed
Claims processor
CLM-425167 → UHC-83435-92 (Randy Jensen)
Member id
UHC-83435-92
Confidence
0.97
Method
deterministic
MBR-033489CLM-425167
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005819
Orphan claim re-pointed
Claims processor
CLM-424062 → UHC-10104-58 (Luis Jones)
Member id
UHC-10104-58
Confidence
0.97
Method
deterministic
MBR-022603CLM-424062
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005820
Orphan claim re-pointed
Claims processor
CLM-405498 → UHC-12383-43 (Ahmed Bailey)
Member id
UHC-12383-43
Confidence
1
Method
probabilistic
MBR-019730CLM-405498
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005821
Orphan claim re-pointed
Claims processor
CLM-416444 → UHC-65456-50 (Janice Ramos)
Member id
UHC-65456-50
Confidence
1
Method
probabilistic
MBR-011714CLM-416444
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005822
Orphan claim re-pointed
Claims processor
CLM-403334 → UHC-94792-89 (Janice Harper)
Member id
UHC-94792-89
Confidence
0.97
Method
deterministic
MBR-024163CLM-403334
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005823
Orphan claim re-pointed
Claims processor
CLM-427416 → UHC-09454-42 (Karen Fowler)
Member id
UHC-09454-42
Confidence
1
Method
probabilistic
MBR-002592CLM-427416
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005824
Orphan claim re-pointed
Claims processor
CLM-425161 → UHC-75033-63 (Joseph Bell)
Member id
UHC-75033-63
Confidence
1
Method
probabilistic
MBR-009201CLM-425161
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005825
Orphan claim re-pointed
Claims processor
CLM-409536 → UHC-14006-97 (Arjun Walsh)
Member id
UHC-14006-97
Confidence
1
Method
probabilistic
MBR-033129CLM-409536
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005826
Orphan claim re-pointed
Claims processor
CLM-400190 → UHC-85133-36 (Jean Torres)
Member id
UHC-85133-36
Confidence
1
Method
probabilistic
MBR-012932CLM-400190
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005827
Orphan claim re-pointed
Claims processor
CLM-406899 → UHC-41769-76 (Barbara Hanson)
Member id
UHC-41769-76
Confidence
0.99
Method
probabilistic
MBR-009642CLM-406899
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005828
Orphan claim re-pointed
Claims processor
CLM-420643 → UHC-67055-10 (Sarah Schmidt)
Member id
UHC-67055-10
Confidence
0.98
Method
probabilistic
MBR-031471CLM-420643
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005829
Orphan claim re-pointed
Claims processor
CLM-411294 → UHC-38480-02 (Kathryn Ross)
Member id
UHC-38480-02
Confidence
0.97
Method
deterministic
MBR-024800CLM-411294
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005830
Orphan claim re-pointed
Claims processor
CLM-404940 → UHC-23727-64 (Zachary Ortega)
Member id
UHC-23727-64
Confidence
0.99
Method
probabilistic
MBR-016485CLM-404940
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005831
Orphan claim re-pointed
Claims processor
CLM-407138 → UHC-72667-92 (Jason Tucker)
Member id
UHC-72667-92
Confidence
1
Method
probabilistic
MBR-010429CLM-407138
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005832
Orphan claim re-pointed
Claims processor
CLM-419583 → UHC-23309-57 (Jesse Harrison)
Member id
UHC-23309-57
Confidence
1
Method
probabilistic
MBR-010825CLM-419583
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005833
Orphan claim re-pointed
Claims processor
CLM-426884 → UHC-10651-17 (Doris Bradley)
Member id
UHC-10651-17
Confidence
1
Method
probabilistic
MBR-025251CLM-426884
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005834
Orphan claim re-pointed
Claims processor
CLM-400990 → UHC-79174-43 (Amber Greene)
Member id
UHC-79174-43
Confidence
1
Method
probabilistic
MBR-016235CLM-400990
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005835
Orphan claim re-pointed
Claims processor
CLM-415703 → UHC-25722-63 (Juan Williams)
Member id
UHC-25722-63
Confidence
1
Method
probabilistic
MBR-019216CLM-415703
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005836
Orphan claim re-pointed
Claims processor
CLM-403153 → UHC-72060-79 (Patrick Carter)
Member id
UHC-72060-79
Confidence
0.93
Method
probabilistic
MBR-023271CLM-403153
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005837
Orphan claim re-pointed
Claims processor
CLM-431702 → UHC-71837-12 (Samuel Gardner)
Member id
UHC-71837-12
Confidence
1
Method
probabilistic
MBR-004364CLM-431702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005838
Orphan claim re-pointed
Claims processor
CLM-418546 → UHC-49440-91 (Jean Wang)
Member id
UHC-49440-91
Confidence
0.99
Method
probabilistic
MBR-000276CLM-418546
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005839
Orphan claim re-pointed
Claims processor
CLM-411341 → UHC-35061-76 (Billy Hansen)
Member id
UHC-35061-76
Confidence
1
Method
probabilistic
MBR-016342CLM-411341
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 90 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.