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-005840
Orphan claim re-pointed
Claims processor
CLM-400281 → UHC-00473-04 (Madison Harris)
Member id
UHC-00473-04
Confidence
1
Method
probabilistic
MBR-021140CLM-400281
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005841
Orphan claim re-pointed
Claims processor
CLM-413279 → UHC-14067-97 (Abigail Dunn)
Member id
UHC-14067-97
Confidence
0.97
Method
deterministic
MBR-028468CLM-413279
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005842
Orphan claim re-pointed
Claims processor
CLM-421380 → UHC-64036-10 (Alexis Hill)
Member id
UHC-64036-10
Confidence
0.99
Method
probabilistic
MBR-005140CLM-421380
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005843
Orphan claim re-pointed
Claims processor
CLM-429869 → UHC-72120-49 (Austin Contreras)
Member id
UHC-72120-49
Confidence
1
Method
probabilistic
MBR-017712CLM-429869
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005844
Orphan claim re-pointed
Claims processor
CLM-424128 → UHC-90970-56 (Justni Boyd)
Member id
UHC-90970-56
Confidence
0.97
Method
deterministic
MBR-016292CLM-424128
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005845
Orphan claim re-pointed
Claims processor
CLM-428937 → UHC-54715-07 (Camila Walker)
Member id
UHC-54715-07
Confidence
0.97
Method
deterministic
MBR-023018CLM-428937
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005846
Orphan claim re-pointed
Claims processor
CLM-414082 → UHC-96632-86 (James Price)
Member id
UHC-96632-86
Confidence
1
Method
probabilistic
MBR-003090CLM-414082
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005847
Orphan claim re-pointed
Claims processor
CLM-428036 → UHC-47330-63 (Doris Rogers)
Member id
UHC-47330-63
Confidence
1
Method
probabilistic
MBR-027057CLM-428036
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005848
Orphan claim re-pointed
Claims processor
CLM-423719 → UHC-82582-51 (Diane Schultz)
Member id
UHC-82582-51
Confidence
1
Method
probabilistic
MBR-022729CLM-423719
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005849
Orphan claim re-pointed
Claims processor
CLM-415802 → UHC-77710-35 (Brian Daniels)
Member id
UHC-77710-35
Confidence
1
Method
probabilistic
MBR-038827CLM-415802
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005850
Orphan claim re-pointed
Claims processor
CLM-412509 → UHC-84016-21 (Carlos Guerrero)
Member id
UHC-84016-21
Confidence
0.99
Method
probabilistic
MBR-004234CLM-412509
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005851
Orphan claim re-pointed
Claims processor
CLM-412312 → UHC-90814-20 (Barbara Schultz)
Member id
UHC-90814-20
Confidence
1
Method
probabilistic
MBR-030313CLM-412312
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005852
Orphan claim re-pointed
Claims processor
CLM-415932 → UHC-24604-43 (Tony Berry)
Member id
UHC-24604-43
Confidence
1
Method
probabilistic
MBR-043160CLM-415932
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005853
Orphan claim re-pointed
Claims processor
CLM-409285 → UHC-53823-26 (Sandra Fox)
Member id
UHC-53823-26
Confidence
1
Method
probabilistic
MBR-033363CLM-409285
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005854
Orphan claim re-pointed
Claims processor
CLM-428811 → UHC-13247-56 (Dylan Lynch)
Member id
UHC-13247-56
Confidence
1
Method
probabilistic
MBR-019643CLM-428811
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005855
Orphan claim re-pointed
Claims processor
CLM-403045 → UHC-44063-25 (Brittany Kim)
Member id
UHC-44063-25
Confidence
1
Method
probabilistic
MBR-023566CLM-403045
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005856
Orphan claim re-pointed
Claims processor
CLM-412847 → UHC-98312-99 (Jerry Romero)
Member id
UHC-98312-99
Confidence
0.97
Method
deterministic
MBR-023099CLM-412847
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005857
Orphan claim re-pointed
Claims processor
CLM-427466 → UHC-46144-67 (Bryan Alvarez)
Member id
UHC-46144-67
Confidence
0.97
Method
deterministic
MBR-013254CLM-427466
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005858
Orphan claim re-pointed
Claims processor
CLM-430975 → UHC-90564-84 (Diane Olson)
Member id
UHC-90564-84
Confidence
1
Method
probabilistic
MBR-005647CLM-430975
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005859
Orphan claim re-pointed
Claims processor
CLM-430274 → UHC-12731-65 (Sofia McCoy)
Member id
UHC-12731-65
Confidence
1
Method
probabilistic
MBR-012905CLM-430274
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005860
Orphan claim re-pointed
Claims processor
CLM-431609 → UHC-75026-55 (Carolyn Flores)
Member id
UHC-75026-55
Confidence
1
Method
probabilistic
MBR-000658CLM-431609
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005861
Orphan claim re-pointed
Claims processor
CLM-429269 → UHC-12979-32 (Amanda Day)
Member id
UHC-12979-32
Confidence
0.97
Method
deterministic
MBR-000047CLM-429269
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005862
Orphan claim re-pointed
Claims processor
CLM-403565 → UHC-64123-35 (Martha Turner)
Member id
UHC-64123-35
Confidence
0.97
Method
deterministic
MBR-034783CLM-403565
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005863
Orphan claim re-pointed
Claims processor
CLM-417300 → UHC-34728-46 (Diego Hunt)
Member id
UHC-34728-46
Confidence
1
Method
probabilistic
MBR-006371CLM-417300
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005864
Orphan claim re-pointed
Claims processor
CLM-409140 → UHC-27852-28 (Kelly Ferguson)
Member id
UHC-27852-28
Confidence
1
Method
probabilistic
MBR-023337CLM-409140
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005865
Orphan claim re-pointed
Claims processor
CLM-410735 → UHC-21146-73 (Christian Gutierrez)
Member id
UHC-21146-73
Confidence
0.97
Method
deterministic
MBR-032257CLM-410735
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005866
Orphan claim re-pointed
Claims processor
CLM-427913 → UHC-01972-71 (Denise Little)
Member id
UHC-01972-71
Confidence
1
Method
probabilistic
MBR-020264CLM-427913
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005867
Orphan claim re-pointed
Claims processor
CLM-426433 → UHC-60488-61 (Jennfier Carroll)
Member id
UHC-60488-61
Confidence
1.00
Method
probabilistic
MBR-025352CLM-426433
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005868
Orphan claim re-pointed
Claims processor
CLM-413858 → UHC-35192-79 (Justin Montgomery)
Member id
UHC-35192-79
Confidence
1
Method
probabilistic
MBR-011199CLM-413858
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005869
Orphan claim re-pointed
Claims processor
CLM-415347 → UHC-43459-75 (Margaret Obrien)
Member id
UHC-43459-75
Confidence
0.97
Method
deterministic
MBR-027484CLM-415347
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005870
Orphan claim re-pointed
Claims processor
CLM-430780 → UHC-14819-53 (Rebecca Jacobs)
Member id
UHC-14819-53
Confidence
0.99
Method
probabilistic
MBR-021607CLM-430780
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005871
Orphan claim re-pointed
Claims processor
CLM-400254 → UHC-21741-37 (Henry Brown)
Member id
UHC-21741-37
Confidence
1
Method
probabilistic
MBR-010847CLM-400254
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005872
Orphan claim re-pointed
Claims processor
CLM-420238 → UHC-80935-14 (Katherine Patel)
Member id
UHC-80935-14
Confidence
1
Method
probabilistic
MBR-007014CLM-420238
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005873
Orphan claim re-pointed
Claims processor
CLM-401835 → UHC-69471-08 (Cynthia Ray)
Member id
UHC-69471-08
Confidence
1.00
Method
probabilistic
MBR-016886CLM-401835
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005874
Orphan claim re-pointed
Claims processor
CLM-405670 → UHC-82913-21 (Diego Johnston)
Member id
UHC-82913-21
Confidence
1
Method
probabilistic
MBR-019899CLM-405670
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005875
Orphan claim re-pointed
Claims processor
CLM-426425 → UHC-56145-05 (Amandda Webre)
Member id
UHC-56145-05
Confidence
0.99
Method
probabilistic
MBR-014042CLM-426425
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005876
Orphan claim re-pointed
Claims processor
CLM-412747 → UHC-33244-23 (Nicole Weber)
Member id
UHC-33244-23
Confidence
1
Method
probabilistic
MBR-010566CLM-412747
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005877
Orphan claim re-pointed
Claims processor
CLM-413848 → UHC-30106-17 (Evelyn Coleman)
Member id
UHC-30106-17
Confidence
1
Method
probabilistic
MBR-002558CLM-413848
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005878
Orphan claim re-pointed
Claims processor
CLM-430832 → UHC-52083-96 (Jesse Kim)
Member id
UHC-52083-96
Confidence
1
Method
probabilistic
MBR-004548CLM-430832
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005879
Orphan claim re-pointed
Claims processor
CLM-414243 → UHC-15395-10 (Jessica Morgan)
Member id
UHC-15395-10
Confidence
1
Method
probabilistic
MBR-015613CLM-414243
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005880
Orphan claim re-pointed
Claims processor
CLM-420119 → UHC-51797-42 (Steven Rios)
Member id
UHC-51797-42
Confidence
1
Method
probabilistic
MBR-021387CLM-420119
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005881
Orphan claim re-pointed
Claims processor
CLM-405603 → UHC-31863-51 (Raymond Gardner)
Member id
UHC-31863-51
Confidence
1
Method
probabilistic
MBR-005342CLM-405603
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005882
Orphan claim re-pointed
Claims processor
CLM-429265 → UHC-49834-84 (Terry Russell)
Member id
UHC-49834-84
Confidence
1
Method
probabilistic
MBR-017538CLM-429265
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005883
Orphan claim re-pointed
Claims processor
CLM-427763 → UHC-67198-90 (David Coleman)
Member id
UHC-67198-90
Confidence
0.93
Method
probabilistic
MBR-026213CLM-427763
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005884
Orphan claim re-pointed
Claims processor
CLM-422301 → UHC-28465-51 (Kimberly Armstrong)
Member id
UHC-28465-51
Confidence
1
Method
probabilistic
MBR-026801CLM-422301
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005885
Orphan claim re-pointed
Claims processor
CLM-418483 → UHC-78489-07 (Yuki Salazar)
Member id
UHC-78489-07
Confidence
0.93
Method
probabilistic
MBR-008998CLM-418483
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005886
Orphan claim re-pointed
Claims processor
CLM-410627 → UHC-86329-70 (Cynthia Ryan)
Member id
UHC-86329-70
Confidence
1
Method
probabilistic
MBR-017658CLM-410627
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005887
Orphan claim re-pointed
Claims processor
CLM-419081 → UHC-49124-60 (Margaret Parker)
Member id
UHC-49124-60
Confidence
0.97
Method
deterministic
MBR-028860CLM-419081
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005888
Orphan claim re-pointed
Claims processor
CLM-402270 → UHC-83618-98 (Camila Martinez)
Member id
UHC-83618-98
Confidence
1
Method
probabilistic
MBR-032157CLM-402270
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005889
Orphan claim re-pointed
Claims processor
CLM-413247 → UHC-30977-89 (Kimberly Lawson)
Member id
UHC-30977-89
Confidence
0.97
Method
deterministic
MBR-016957CLM-413247
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 91 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.