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-007090
Orphan claim re-pointed
Claims processor
CLM-408372 → UHC-17896-01 (Anna Coleman)
Member id
UHC-17896-01
Confidence
0.99
Method
probabilistic
MBR-012572CLM-408372
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007091
Orphan claim re-pointed
Claims processor
CLM-414886 → UHC-48337-47 (David Ryan)
Member id
UHC-48337-47
Confidence
1
Method
probabilistic
MBR-020233CLM-414886
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007092
Orphan claim re-pointed
Claims processor
CLM-413761 → UHC-84921-80 (Andrea Wilson)
Member id
UHC-84921-80
Confidence
1
Method
probabilistic
MBR-006423CLM-413761
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007093
Orphan claim re-pointed
Claims processor
CLM-400088 → UHC-61834-78 (Wei Garza)
Member id
UHC-61834-78
Confidence
1
Method
probabilistic
MBR-019651CLM-400088
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007094
Orphan claim re-pointed
Claims processor
CLM-429293 → UHC-35294-47 (Ethan Ruiz)
Member id
UHC-35294-47
Confidence
1
Method
probabilistic
MBR-009820CLM-429293
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007095
Orphan claim re-pointed
Claims processor
CLM-405667 → UHC-41947-43 (Jacqueline Fowler)
Member id
UHC-41947-43
Confidence
1
Method
probabilistic
MBR-037989CLM-405667
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007096
Orphan claim re-pointed
Claims processor
CLM-429225 → UHC-11820-74 (Steven Wheeler)
Member id
UHC-11820-74
Confidence
1
Method
probabilistic
MBR-037825CLM-429225
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007097
Orphan claim re-pointed
Claims processor
CLM-412634 → UHC-56622-34 (Mateo Estrada)
Member id
UHC-56622-34
Confidence
1
Method
probabilistic
MBR-006530CLM-412634
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007098
Orphan claim re-pointed
Claims processor
CLM-425606 → UHC-75343-29 (Lauren Wang)
Member id
UHC-75343-29
Confidence
1
Method
probabilistic
MBR-000146CLM-425606
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007099
Orphan claim re-pointed
Claims processor
CLM-409255 → UHC-15357-52 (Douglas Harris)
Member id
UHC-15357-52
Confidence
0.97
Method
deterministic
MBR-036271CLM-409255
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007100
Orphan claim re-pointed
Claims processor
CLM-402800 → UHC-70158-96 (Timothy Wilson)
Member id
UHC-70158-96
Confidence
1
Method
probabilistic
MBR-026366CLM-402800
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007101
Orphan claim re-pointed
Claims processor
CLM-423088 → UHC-83540-64 (Emily Fox)
Member id
UHC-83540-64
Confidence
0.93
Method
probabilistic
MBR-036884CLM-423088
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007102
Orphan claim re-pointed
Claims processor
CLM-415521 → UHC-33418-96 (Bruce Reynolds)
Member id
UHC-33418-96
Confidence
1
Method
probabilistic
MBR-023552CLM-415521
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007103
Orphan claim re-pointed
Claims processor
CLM-429559 → UHC-66040-77 (Bruce Alexander)
Member id
UHC-66040-77
Confidence
1
Method
probabilistic
MBR-025301CLM-429559
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007104
Orphan claim re-pointed
Claims processor
CLM-421335 → UHC-16004-64 (Maria Spencer)
Member id
UHC-16004-64
Confidence
0.97
Method
deterministic
MBR-004414CLM-421335
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007105
Orphan claim re-pointed
Claims processor
CLM-415775 → UHC-50584-31 (Sara Estrada)
Member id
UHC-50584-31
Confidence
0.99
Method
probabilistic
MBR-003264CLM-415775
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007106
Orphan claim re-pointed
Claims processor
CLM-401317 → UHC-47254-57 (Marilyn Miller)
Member id
UHC-47254-57
Confidence
0.97
Method
deterministic
MBR-001763CLM-401317
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007107
Orphan claim re-pointed
Claims processor
CLM-431657 → UHC-98030-27 (Billy Fisher)
Member id
UHC-98030-27
Confidence
1
Method
probabilistic
MBR-004925CLM-431657
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007108
Orphan claim re-pointed
Claims processor
CLM-400988 → UHC-53067-61 (Gloria Moore)
Member id
UHC-53067-61
Confidence
1
Method
probabilistic
MBR-009800CLM-400988
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007109
Orphan claim re-pointed
Claims processor
CLM-417531 → UHC-30073-49 (Jeffrey Singh)
Member id
UHC-30073-49
Confidence
1
Method
probabilistic
MBR-015868CLM-417531
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007110
Orphan claim re-pointed
Claims processor
CLM-410001 → UHC-04817-13 (Priya McDonald)
Member id
UHC-04817-13
Confidence
1
Method
probabilistic
MBR-007102CLM-410001
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007111
Orphan claim re-pointed
Claims processor
CLM-402212 → UHC-27777-76 (Edward Garrett)
Member id
UHC-27777-76
Confidence
1
Method
probabilistic
MBR-038812CLM-402212
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007112
Orphan claim re-pointed
Claims processor
CLM-402657 → UHC-09595-21 (Kathleen Hanson)
Member id
UHC-09595-21
Confidence
0.93
Method
probabilistic
MBR-000630CLM-402657
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007113
Orphan claim re-pointed
Claims processor
CLM-408174 → UHC-11325-94 (Kenneth Kelly)
Member id
UHC-11325-94
Confidence
1
Method
probabilistic
MBR-004686CLM-408174
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007114
Orphan claim re-pointed
Claims processor
CLM-412147 → UHC-48458-09 (Ronald Lopez)
Member id
UHC-48458-09
Confidence
0.99
Method
probabilistic
MBR-002352CLM-412147
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007115
Orphan claim re-pointed
Claims processor
CLM-432024 → UHC-86823-72 (Randy Parker)
Member id
UHC-86823-72
Confidence
1
Method
probabilistic
MBR-000705CLM-432024
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007116
Orphan claim re-pointed
Claims processor
CLM-405786 → UHC-81514-74 (Amanda Larson)
Member id
UHC-81514-74
Confidence
1
Method
probabilistic
MBR-017552CLM-405786
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007117
Orphan claim re-pointed
Claims processor
CLM-406905 → UHC-99232-21 (Lawrence Rice)
Member id
UHC-99232-21
Confidence
0.97
Method
deterministic
MBR-032922CLM-406905
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007118
Orphan claim re-pointed
Claims processor
CLM-420954 → UHC-43105-62 (Denise White)
Member id
UHC-43105-62
Confidence
1
Method
probabilistic
MBR-006305CLM-420954
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007119
Orphan claim re-pointed
Claims processor
CLM-417007 → UHC-49436-32 (Madison Taylor)
Member id
UHC-49436-32
Confidence
1
Method
probabilistic
MBR-027985CLM-417007
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007120
Orphan claim re-pointed
Claims processor
CLM-417767 → UHC-90635-30 (Justin Johnson)
Member id
UHC-90635-30
Confidence
1
Method
probabilistic
MBR-030461CLM-417767
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007121
Orphan claim re-pointed
Claims processor
CLM-405144 → UHC-68210-89 (Alexis Ramirez)
Member id
UHC-68210-89
Confidence
0.97
Method
deterministic
MBR-001796CLM-405144
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007122
Orphan claim re-pointed
Claims processor
CLM-425702 → UHC-87716-71 (Betty Willis)
Member id
UHC-87716-71
Confidence
1
Method
probabilistic
MBR-015683CLM-425702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007123
Orphan claim re-pointed
Claims processor
CLM-408457 → UHC-56014-62 (Tony Luna)
Member id
UHC-56014-62
Confidence
1
Method
probabilistic
MBR-013071CLM-408457
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007124
Orphan claim re-pointed
Claims processor
CLM-428384 → UHC-44333-96 (Danielle Fox)
Member id
UHC-44333-96
Confidence
1
Method
probabilistic
MBR-006616CLM-428384
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007125
Orphan claim re-pointed
Claims processor
CLM-413629 → UHC-64031-66 (Keith Banks)
Member id
UHC-64031-66
Confidence
1
Method
probabilistic
MBR-029725CLM-413629
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007126
Orphan claim re-pointed
Claims processor
CLM-403850 → UHC-60731-35 (Larry Arnold)
Member id
UHC-60731-35
Confidence
1
Method
probabilistic
MBR-009807CLM-403850
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007127
Orphan claim re-pointed
Claims processor
CLM-425860 → UHC-68692-18 (Donna Reed)
Member id
UHC-68692-18
Confidence
1
Method
probabilistic
MBR-001647CLM-425860
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007128
Orphan claim re-pointed
Claims processor
CLM-403248 → UHC-66774-91 (Kenneth Martinez)
Member id
UHC-66774-91
Confidence
1
Method
probabilistic
MBR-016078CLM-403248
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007129
Orphan claim re-pointed
Claims processor
CLM-428623 → UHC-25585-33 (Martha Washington)
Member id
UHC-25585-33
Confidence
1
Method
probabilistic
MBR-019322CLM-428623
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007130
Orphan claim re-pointed
Claims processor
CLM-413571 → UHC-97811-68 (Jonathan Freeman)
Member id
UHC-97811-68
Confidence
1.00
Method
probabilistic
MBR-022522CLM-413571
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007131
Orphan claim re-pointed
Claims processor
CLM-405396 → UHC-39143-11 (Rebecca Austin)
Member id
UHC-39143-11
Confidence
1
Method
probabilistic
MBR-034784CLM-405396
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007132
Orphan claim re-pointed
Claims processor
CLM-423288 → UHC-25477-10 (Richard Hansen)
Member id
UHC-25477-10
Confidence
1
Method
probabilistic
MBR-011482CLM-423288
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007133
Orphan claim re-pointed
Claims processor
CLM-404837 → UHC-98156-98 (Terry Watson)
Member id
UHC-98156-98
Confidence
1
Method
probabilistic
MBR-022161CLM-404837
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007134
Orphan claim re-pointed
Claims processor
CLM-426837 → UHC-26419-88 (Joe Bishop)
Member id
UHC-26419-88
Confidence
1
Method
probabilistic
MBR-009976CLM-426837
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007135
Orphan claim re-pointed
Claims processor
CLM-411448 → UHC-73234-71 (Jacob Rios)
Member id
UHC-73234-71
Confidence
0.99
Method
probabilistic
MBR-015687CLM-411448
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007136
Orphan claim re-pointed
Claims processor
CLM-400431 → UHC-60033-71 (Bradley Carroll)
Member id
UHC-60033-71
Confidence
0.99
Method
probabilistic
MBR-016939CLM-400431
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007137
Orphan claim re-pointed
Claims processor
CLM-430441 → UHC-60914-75 (Gerald Anderson)
Member id
UHC-60914-75
Confidence
1
Method
probabilistic
MBR-004914CLM-430441
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007138
Orphan claim re-pointed
Claims processor
CLM-407700 → UHC-80137-83 (Roger George)
Member id
UHC-80137-83
Confidence
1
Method
probabilistic
MBR-015051CLM-407700
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007139
Orphan claim re-pointed
Claims processor
CLM-401817 → UHC-66810-53 (Carlos Wood)
Member id
UHC-66810-53
Confidence
0.93
Method
probabilistic
MBR-020446CLM-401817
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 116 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.