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

TypeAllEligibility conflict resolved1,339Orphan claim re-pointed9,112Outreach address corrected2,993Outreach suppressed pending steward4,326Care coordination outreach1,815New member onboarding2,081Duplicate member record retired4,974
StatusAllProposed8,228Executed14,086Held4,326Released0
ActionTypeTitleDetailLinked toStatusExecuted
ACT-001840
Orphan claim re-pointed
Claims processor
CLM-407123 → UHC-54614-81 (Gerald Kennedy)
Member id
UHC-54614-81
Confidence
0.99
Method
probabilistic
MBR-008691CLM-407123
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001841
Orphan claim re-pointed
Claims processor
CLM-410217 → UHC-06564-81 (David Yang)
Member id
UHC-06564-81
Confidence
1
Method
probabilistic
MBR-018330CLM-410217
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001842
Orphan claim re-pointed
Claims processor
CLM-416307 → UHC-14526-69 (Virginia Hunter)
Member id
UHC-14526-69
Confidence
0.97
Method
deterministic
MBR-039442CLM-416307
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001843
Orphan claim re-pointed
Claims processor
CLM-420069 → UHC-13976-98 (Emma Ramos)
Member id
UHC-13976-98
Confidence
1
Method
probabilistic
MBR-015329CLM-420069
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001844
Orphan claim re-pointed
Claims processor
CLM-428714 → UHC-81755-94 (Omar Cruz)
Member id
UHC-81755-94
Confidence
1
Method
probabilistic
MBR-031151CLM-428714
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001845
Orphan claim re-pointed
Claims processor
CLM-417167 → UHC-31996-82 (Matthew Williamson)
Member id
UHC-31996-82
Confidence
1
Method
probabilistic
MBR-024817CLM-417167
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001846
Orphan claim re-pointed
Claims processor
CLM-412682 → UHC-56887-73 (Luis Lee)
Member id
UHC-56887-73
Confidence
0.99
Method
probabilistic
MBR-008147CLM-412682
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001847
Orphan claim re-pointed
Claims processor
CLM-428705 → UHC-76593-95 (Kathryn Carlson)
Member id
UHC-76593-95
Confidence
0.97
Method
deterministic
MBR-008784CLM-428705
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001848
Orphan claim re-pointed
Claims processor
CLM-413479 → UHC-29432-01 (Carol Gonzalez)
Member id
UHC-29432-01
Confidence
1
Method
probabilistic
MBR-010914CLM-413479
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001849
Orphan claim re-pointed
Claims processor
CLM-430086 → UHC-35018-52 (Amy Butler)
Member id
UHC-35018-52
Confidence
1
Method
probabilistic
MBR-019760CLM-430086
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001850
Orphan claim re-pointed
Claims processor
CLM-410909 → UHC-70476-15 (Carol Hughes)
Member id
UHC-70476-15
Confidence
1
Method
probabilistic
MBR-041840CLM-410909
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001851
Orphan claim re-pointed
Claims processor
CLM-406832 → UHC-83948-75 (Philip Woods)
Member id
UHC-83948-75
Confidence
1.00
Method
probabilistic
MBR-012019CLM-406832
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001852
Orphan claim re-pointed
Claims processor
CLM-422209 → UHC-89453-55 (Vincent Morgan)
Member id
UHC-89453-55
Confidence
0.97
Method
deterministic
MBR-000577CLM-422209
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001853
Orphan claim re-pointed
Claims processor
CLM-432164 → UHC-72535-35 (Rachel Holmes)
Member id
UHC-72535-35
Confidence
1
Method
probabilistic
MBR-015508CLM-432164
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001854
Orphan claim re-pointed
Claims processor
CLM-410999 → UHC-77031-08 (Jimmy Watkins)
Member id
UHC-77031-08
Confidence
1
Method
probabilistic
MBR-002822CLM-410999
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001855
Orphan claim re-pointed
Claims processor
CLM-402758 → UHC-45402-41 (James Ortiz)
Member id
UHC-45402-41
Confidence
1
Method
probabilistic
MBR-034607CLM-402758
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001856
Orphan claim re-pointed
Claims processor
CLM-432560 → UHC-35446-77 (Amanda Bennett)
Member id
UHC-35446-77
Confidence
1
Method
probabilistic
MBR-000305CLM-432560
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001857
Orphan claim re-pointed
Claims processor
CLM-432419 → UHC-25443-03 (Barbara Nichols)
Member id
UHC-25443-03
Confidence
1
Method
probabilistic
MBR-018489CLM-432419
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001858
Orphan claim re-pointed
Claims processor
CLM-417706 → UHC-77127-65 (Betty Knight)
Member id
UHC-77127-65
Confidence
0.97
Method
deterministic
MBR-007290CLM-417706
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001859
Orphan claim re-pointed
Claims processor
CLM-418167 → UHC-71686-49 (Ana Jackson)
Member id
UHC-71686-49
Confidence
1
Method
probabilistic
MBR-031010CLM-418167
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001860
Orphan claim re-pointed
Claims processor
CLM-429823 → UHC-09008-65 (Hannah Larson)
Member id
UHC-09008-65
Confidence
1
Method
probabilistic
MBR-000237CLM-429823
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001861
Orphan claim re-pointed
Claims processor
CLM-401161 → UHC-58991-88 (Bryan Hansen)
Member id
UHC-58991-88
Confidence
1
Method
probabilistic
MBR-001466CLM-401161
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001862
Orphan claim re-pointed
Claims processor
CLM-420984 → UHC-75457-07 (Emily Owens)
Member id
UHC-75457-07
Confidence
1
Method
probabilistic
MBR-019813CLM-420984
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001863
Orphan claim re-pointed
Claims processor
CLM-423811 → UHC-01960-86 (Cynthia Castro)
Member id
UHC-01960-86
Confidence
1
Method
probabilistic
MBR-020040CLM-423811
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001864
Orphan claim re-pointed
Claims processor
CLM-423356 → UHC-55513-50 (Aaron Aguilar)
Member id
UHC-55513-50
Confidence
1
Method
probabilistic
MBR-002940CLM-423356
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001865
Orphan claim re-pointed
Claims processor
CLM-419738 → UHC-37330-92 (Kathryn Day)
Member id
UHC-37330-92
Confidence
1
Method
probabilistic
MBR-021464CLM-419738
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001866
Orphan claim re-pointed
Claims processor
CLM-410185 → UHC-50173-29 (Sarah Crawford)
Member id
UHC-50173-29
Confidence
0.93
Method
probabilistic
MBR-023665CLM-410185
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001867
Orphan claim re-pointed
Claims processor
CLM-429040 → UHC-34224-49 (Mei Thompson)
Member id
UHC-34224-49
Confidence
0.97
Method
deterministic
MBR-044277CLM-429040
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001868
Orphan claim re-pointed
Claims processor
CLM-403320 → UHC-16432-60 (Steven Fox)
Member id
UHC-16432-60
Confidence
0.97
Method
deterministic
MBR-025061CLM-403320
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001869
Orphan claim re-pointed
Claims processor
CLM-416105 → UHC-44697-32 (Jon Oliver)
Member id
UHC-44697-32
Confidence
1
Method
probabilistic
MBR-005895CLM-416105
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001870
Orphan claim re-pointed
Claims processor
CLM-421753 → UHC-84718-34 (Linda Johnson)
Member id
UHC-84718-34
Confidence
1
Method
probabilistic
MBR-032292CLM-421753
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001871
Orphan claim re-pointed
Claims processor
CLM-432184 → UHC-41395-61 (Madison Allen)
Member id
UHC-41395-61
Confidence
0.97
Method
deterministic
MBR-002931CLM-432184
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001872
Orphan claim re-pointed
Claims processor
CLM-404785 → UHC-44621-72 (Salazar Christian)
Member id
UHC-44621-72
Confidence
0.97
Method
probabilistic
MBR-005372CLM-404785
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001873
Orphan claim re-pointed
Claims processor
CLM-425051 → UHC-92395-20 (Charles Ortiz)
Member id
UHC-92395-20
Confidence
1
Method
probabilistic
MBR-005373CLM-425051
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001874
Orphan claim re-pointed
Claims processor
CLM-432304 → UHC-41143-37 (Kayla Valdez)
Member id
UHC-41143-37
Confidence
1
Method
probabilistic
MBR-004577CLM-432304
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001875
Orphan claim re-pointed
Claims processor
CLM-405084 → UHC-84948-25 (Judith Lopez)
Member id
UHC-84948-25
Confidence
1
Method
probabilistic
MBR-003221CLM-405084
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001876
Orphan claim re-pointed
Claims processor
CLM-417320 → UHC-81179-53 (Alexis Walker)
Member id
UHC-81179-53
Confidence
0.93
Method
probabilistic
MBR-016410CLM-417320
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001877
Orphan claim re-pointed
Claims processor
CLM-401007 → UHC-31657-36 (Beverly Dominguez)
Member id
UHC-31657-36
Confidence
1
Method
probabilistic
MBR-024670CLM-401007
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001878
Orphan claim re-pointed
Claims processor
CLM-423818 → UHC-34539-08 (Yuki Johnson)
Member id
UHC-34539-08
Confidence
1
Method
probabilistic
MBR-014044CLM-423818
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001879
Orphan claim re-pointed
Claims processor
CLM-430421 → UHC-45196-98 (Dennis Nelson)
Member id
UHC-45196-98
Confidence
0.97
Method
deterministic
MBR-039578CLM-430421
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001880
Orphan claim re-pointed
Claims processor
CLM-422168 → UHC-96032-88 (Virginia Hawkins)
Member id
UHC-96032-88
Confidence
1
Method
probabilistic
MBR-020502CLM-422168
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001881
Orphan claim re-pointed
Claims processor
CLM-407394 → UHC-82109-72 (Madison Moreno)
Member id
UHC-82109-72
Confidence
0.99
Method
probabilistic
MBR-026520CLM-407394
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001882
Orphan claim re-pointed
Claims processor
CLM-413890 → UHC-46770-67 (Anthony Davis)
Member id
UHC-46770-67
Confidence
1
Method
probabilistic
MBR-011565CLM-413890
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001883
Orphan claim re-pointed
Claims processor
CLM-410231 → UHC-60881-82 (Paul Bryant)
Member id
UHC-60881-82
Confidence
0.99
Method
probabilistic
MBR-029355CLM-410231
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001884
Orphan claim re-pointed
Claims processor
CLM-411429 → UHC-94285-65 (Jeremy Holmes)
Member id
UHC-94285-65
Confidence
1
Method
probabilistic
MBR-019265CLM-411429
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001885
Orphan claim re-pointed
Claims processor
CLM-428000 → UHC-92037-28 (Daniel Gilbert)
Member id
UHC-92037-28
Confidence
1
Method
probabilistic
MBR-022826CLM-428000
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001886
Orphan claim re-pointed
Claims processor
CLM-407718 → UHC-21792-24 (Natalie Wallace)
Member id
UHC-21792-24
Confidence
1
Method
probabilistic
MBR-009462CLM-407718
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001887
Orphan claim re-pointed
Claims processor
CLM-426630 → UHC-62320-38 (Barbara Cooper)
Member id
UHC-62320-38
Confidence
1
Method
probabilistic
MBR-012284CLM-426630
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001888
Orphan claim re-pointed
Claims processor
CLM-405844 → UHC-70283-31 (Randy Reid)
Member id
UHC-70283-31
Confidence
1
Method
probabilistic
MBR-012652CLM-405844
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001889
Orphan claim re-pointed
Claims processor
CLM-411777 → UHC-43485-07 (Laura Ruiz)
Member id
UHC-43485-07
Confidence
0.93
Method
probabilistic
MBR-001748CLM-411777
Executed
resolution_agent
2026-10-19 19:54:39
14,086 rows, page 11 of 282PreviousNext

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.