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-005940
Orphan claim re-pointed
Claims processor
CLM-426563 → UHC-72208-98 (Sara Franklin)
Member id
UHC-72208-98
Confidence
0.97
Method
deterministic
MBR-037870CLM-426563
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005941
Orphan claim re-pointed
Claims processor
CLM-432228 → UHC-45743-43 (Wayne Contreras)
Member id
UHC-45743-43
Confidence
0.97
Method
deterministic
MBR-020135CLM-432228
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005942
Orphan claim re-pointed
Claims processor
CLM-400215 → UHC-17817-28 (Harold Pena)
Member id
UHC-17817-28
Confidence
1
Method
probabilistic
MBR-011646CLM-400215
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005943
Orphan claim re-pointed
Claims processor
CLM-400891 → UHC-49242-29 (Ashley Thomas)
Member id
UHC-49242-29
Confidence
1
Method
probabilistic
MBR-012554CLM-400891
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005944
Orphan claim re-pointed
Claims processor
CLM-422556 → UHC-66516-34 (Benjamin Payne)
Member id
UHC-66516-34
Confidence
1
Method
probabilistic
MBR-008089CLM-422556
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005945
Orphan claim re-pointed
Claims processor
CLM-400370 → UHC-52024-75 (Grace Burton)
Member id
UHC-52024-75
Confidence
0.99
Method
probabilistic
MBR-031731CLM-400370
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005946
Orphan claim re-pointed
Claims processor
CLM-424413 → UHC-51204-16 (Jerry Edwards)
Member id
UHC-51204-16
Confidence
0.99
Method
probabilistic
MBR-040149CLM-424413
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005947
Orphan claim re-pointed
Claims processor
CLM-408256 → UHC-95675-57 (Kayla Chen)
Member id
UHC-95675-57
Confidence
1
Method
probabilistic
MBR-001335CLM-408256
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005948
Orphan claim re-pointed
Claims processor
CLM-422798 → UHC-87251-20 (Shirley Hunter)
Member id
UHC-87251-20
Confidence
1
Method
probabilistic
MBR-021914CLM-422798
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005949
Orphan claim re-pointed
Claims processor
CLM-415000 → UHC-74723-28 (Roy Reid)
Member id
UHC-74723-28
Confidence
1
Method
probabilistic
MBR-009974CLM-415000
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005950
Orphan claim re-pointed
Claims processor
CLM-410780 → UHC-75557-23 (Judy Martin)
Member id
UHC-75557-23
Confidence
1
Method
probabilistic
MBR-013778CLM-410780
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005951
Orphan claim re-pointed
Claims processor
CLM-418250 → UHC-45600-90 (Sharon Mendoza)
Member id
UHC-45600-90
Confidence
1
Method
probabilistic
MBR-017506CLM-418250
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005952
Orphan claim re-pointed
Claims processor
CLM-428206 → UHC-69971-22 (Russell Fowler)
Member id
UHC-69971-22
Confidence
0.99
Method
probabilistic
MBR-014743CLM-428206
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005953
Orphan claim re-pointed
Claims processor
CLM-432114 → UHC-50358-46 (Julie Miller)
Member id
UHC-50358-46
Confidence
0.94
Method
probabilistic
MBR-006733CLM-432114
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005954
Orphan claim re-pointed
Claims processor
CLM-421528 → UHC-96605-12 (Omar Webb)
Member id
UHC-96605-12
Confidence
0.98
Method
probabilistic
MBR-044446CLM-421528
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005955
Orphan claim re-pointed
Claims processor
CLM-408645 → UHC-16249-96 (Nicholas Lane)
Member id
UHC-16249-96
Confidence
0.97
Method
deterministic
MBR-040874CLM-408645
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005956
Orphan claim re-pointed
Claims processor
CLM-411620 → UHC-99981-18 (Olivia Espinoza)
Member id
UHC-99981-18
Confidence
1
Method
probabilistic
MBR-012349CLM-411620
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005957
Orphan claim re-pointed
Claims processor
CLM-431780 → UHC-07698-10 (Ashley Singh)
Member id
UHC-07698-10
Confidence
0.97
Method
deterministic
MBR-019957CLM-431780
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005958
Orphan claim re-pointed
Claims processor
CLM-417837 → UHC-82219-84 (Michael Lynch)
Member id
UHC-82219-84
Confidence
1
Method
probabilistic
MBR-016811CLM-417837
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005959
Orphan claim re-pointed
Claims processor
CLM-406495 → UHC-54871-91 (Omar Torres)
Member id
UHC-54871-91
Confidence
0.97
Method
deterministic
MBR-024385CLM-406495
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005960
Orphan claim re-pointed
Claims processor
CLM-424074 → UHC-66712-26 (Lawrence Hayes)
Member id
UHC-66712-26
Confidence
1
Method
probabilistic
MBR-014069CLM-424074
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005961
Orphan claim re-pointed
Claims processor
CLM-402706 → UHC-79002-63 (Russell Berry)
Member id
UHC-79002-63
Confidence
0.97
Method
deterministic
MBR-009989CLM-402706
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005962
Orphan claim re-pointed
Claims processor
CLM-409344 → UHC-22188-38 (Anthony Fisher)
Member id
UHC-22188-38
Confidence
1
Method
probabilistic
MBR-025623CLM-409344
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005963
Orphan claim re-pointed
Claims processor
CLM-401025 → UHC-89960-59 (Maria Long)
Member id
UHC-89960-59
Confidence
1
Method
probabilistic
MBR-022067CLM-401025
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005964
Orphan claim re-pointed
Claims processor
CLM-401192 → UHC-05445-31 (Dennis Li)
Member id
UHC-05445-31
Confidence
1
Method
probabilistic
MBR-031595CLM-401192
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005965
Orphan claim re-pointed
Claims processor
CLM-415545 → UHC-20729-69 (Andrew Romero)
Member id
UHC-20729-69
Confidence
1
Method
probabilistic
MBR-028338CLM-415545
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005966
Orphan claim re-pointed
Claims processor
CLM-410832 → UHC-52432-11 (Edward Daniels)
Member id
UHC-52432-11
Confidence
1.00
Method
probabilistic
MBR-012422CLM-410832
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005967
Orphan claim re-pointed
Claims processor
CLM-414503 → UHC-26652-20 (Brandon Torres)
Member id
UHC-26652-20
Confidence
1
Method
probabilistic
MBR-009781CLM-414503
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005968
Orphan claim re-pointed
Claims processor
CLM-411258 → UHC-34912-78 (Jessica Vargas)
Member id
UHC-34912-78
Confidence
1
Method
probabilistic
MBR-000636CLM-411258
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005969
Orphan claim re-pointed
Claims processor
CLM-400180 → UHC-95243-62 (Camila Jimenez)
Member id
UHC-95243-62
Confidence
1
Method
probabilistic
MBR-012348CLM-400180
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005970
Orphan claim re-pointed
Claims processor
CLM-415810 → UHC-93864-36 (Steven Boyd)
Member id
UHC-93864-36
Confidence
1
Method
probabilistic
MBR-014735CLM-415810
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005971
Orphan claim re-pointed
Claims processor
CLM-419249 → UHC-73414-40 (Marcus Carroll)
Member id
UHC-73414-40
Confidence
0.97
Method
deterministic
MBR-029597CLM-419249
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005972
Orphan claim re-pointed
Claims processor
CLM-406753 → UHC-53525-01 (Gary Harvey)
Member id
UHC-53525-01
Confidence
1
Method
probabilistic
MBR-026832CLM-406753
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005973
Orphan claim re-pointed
Claims processor
CLM-402024 → UHC-16733-85 (Elijah Ray)
Member id
UHC-16733-85
Confidence
1
Method
probabilistic
MBR-004775CLM-402024
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005974
Orphan claim re-pointed
Claims processor
CLM-429703 → UHC-09752-86 (Joshua Park)
Member id
UHC-09752-86
Confidence
1
Method
probabilistic
MBR-022251CLM-429703
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005975
Orphan claim re-pointed
Claims processor
CLM-430791 → UHC-08546-06 (Cynthia Sullivan)
Member id
UHC-08546-06
Confidence
1
Method
probabilistic
MBR-011114CLM-430791
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005976
Orphan claim re-pointed
Claims processor
CLM-430577 → UHC-01568-37 (Arthur Robertson)
Member id
UHC-01568-37
Confidence
0.99
Method
probabilistic
MBR-005446CLM-430577
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005977
Orphan claim re-pointed
Claims processor
CLM-412183 → UHC-00823-45 (Kathryn Hart)
Member id
UHC-00823-45
Confidence
1
Method
probabilistic
MBR-010033CLM-412183
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005978
Orphan claim re-pointed
Claims processor
CLM-400714 → UHC-78677-80 (Matt Hayes)
Member id
UHC-78677-80
Confidence
0.99
Method
probabilistic
MBR-019929CLM-400714
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005979
Orphan claim re-pointed
Claims processor
CLM-421573 → UHC-84552-22 (Diego Espinoza)
Member id
UHC-84552-22
Confidence
0.93
Method
probabilistic
MBR-011465CLM-421573
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005980
Orphan claim re-pointed
Claims processor
CLM-420503 → UHC-14729-92 (Keith Diaz)
Member id
UHC-14729-92
Confidence
1
Method
probabilistic
MBR-006571CLM-420503
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005981
Orphan claim re-pointed
Claims processor
CLM-431915 → UHC-57612-75 (Juan Myers)
Member id
UHC-57612-75
Confidence
1
Method
probabilistic
MBR-010066CLM-431915
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005982
Orphan claim re-pointed
Claims processor
CLM-416365 → UHC-95105-58 (Ruth Gray)
Member id
UHC-95105-58
Confidence
0.99
Method
probabilistic
MBR-021250CLM-416365
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005983
Orphan claim re-pointed
Claims processor
CLM-416553 → UHC-75701-22 (Keith Ortiz)
Member id
UHC-75701-22
Confidence
0.99
Method
probabilistic
MBR-008520CLM-416553
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005984
Orphan claim re-pointed
Claims processor
CLM-421462 → UHC-12228-04 (Juan Kelly)
Member id
UHC-12228-04
Confidence
0.85
Method
probabilistic
MBR-019800CLM-421462
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005985
Orphan claim re-pointed
Claims processor
CLM-425329 → UHC-34873-58 (Amber Contreras)
Member id
UHC-34873-58
Confidence
1
Method
probabilistic
MBR-037778CLM-425329
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005986
Orphan claim re-pointed
Claims processor
CLM-404464 → UHC-46738-13 (Bruce Stephens)
Member id
UHC-46738-13
Confidence
1
Method
probabilistic
MBR-011551CLM-404464
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005987
Orphan claim re-pointed
Claims processor
CLM-415541 → UHC-50444-71 (Kenneth Morgan)
Member id
UHC-50444-71
Confidence
1
Method
probabilistic
MBR-042473CLM-415541
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005988
Orphan claim re-pointed
Claims processor
CLM-408425 → UHC-02437-39 (Mark Woods)
Member id
UHC-02437-39
Confidence
0.97
Method
deterministic
MBR-012506CLM-408425
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005989
Orphan claim re-pointed
Claims processor
CLM-400338 → UHC-15915-54 (Ralph Little)
Member id
UHC-15915-54
Confidence
0.97
Method
deterministic
MBR-028190CLM-400338
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 93 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.