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-001940
Orphan claim re-pointed
Claims processor
CLM-403316 → UHC-33275-94 (Scott Barnes)
Member id
UHC-33275-94
Confidence
0.97
Method
deterministic
MBR-026279CLM-403316
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001941
Orphan claim re-pointed
Claims processor
CLM-424825 → UHC-99586-03 (Dennis Thompson)
Member id
UHC-99586-03
Confidence
0.86
Method
probabilistic
MBR-010716CLM-424825
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001942
Orphan claim re-pointed
Claims processor
CLM-406473 → UHC-44301-74 (Laura Ryan)
Member id
UHC-44301-74
Confidence
1
Method
probabilistic
MBR-008346CLM-406473
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001943
Orphan claim re-pointed
Claims processor
CLM-421727 → UHC-88787-58 (Mason Garrett)
Member id
UHC-88787-58
Confidence
1
Method
probabilistic
MBR-007987CLM-421727
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001944
Orphan claim re-pointed
Claims processor
CLM-412984 → UHC-09672-15 (Katherine Dixon)
Member id
UHC-09672-15
Confidence
1
Method
probabilistic
MBR-007502CLM-412984
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001945
Orphan claim re-pointed
Claims processor
CLM-427208 → UHC-79652-17 (Julei Franklin)
Member id
UHC-79652-17
Confidence
0.97
Method
deterministic
MBR-005845CLM-427208
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001946
Orphan claim re-pointed
Claims processor
CLM-427555 → UHC-47559-10 (Kimberly Wood)
Member id
UHC-47559-10
Confidence
0.97
Method
deterministic
MBR-007572CLM-427555
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001947
Orphan claim re-pointed
Claims processor
CLM-414755 → UHC-87599-06 (Sandra Simmons)
Member id
UHC-87599-06
Confidence
0.97
Method
deterministic
MBR-029877CLM-414755
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001948
Orphan claim re-pointed
Claims processor
CLM-406282 → UHC-30938-27 (Eric Reed)
Member id
UHC-30938-27
Confidence
0.93
Method
probabilistic
MBR-015322CLM-406282
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001949
Orphan claim re-pointed
Claims processor
CLM-411096 → UHC-39290-82 (Brittany Stephens)
Member id
UHC-39290-82
Confidence
1
Method
probabilistic
MBR-015977CLM-411096
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001950
Orphan claim re-pointed
Claims processor
CLM-409163 → UHC-16666-12 (Nicole Carter)
Member id
UHC-16666-12
Confidence
1
Method
probabilistic
MBR-010513CLM-409163
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001951
Orphan claim re-pointed
Claims processor
CLM-410705 → UHC-58876-62 (Jacob Johnston)
Member id
UHC-58876-62
Confidence
1
Method
probabilistic
MBR-027456CLM-410705
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001952
Orphan claim re-pointed
Claims processor
CLM-428457 → UHC-75478-15 (Judith Castillo)
Member id
UHC-75478-15
Confidence
1
Method
probabilistic
MBR-012296CLM-428457
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001953
Orphan claim re-pointed
Claims processor
CLM-420147 → UHC-21009-42 (Susan Yang)
Member id
UHC-21009-42
Confidence
1
Method
probabilistic
MBR-007685CLM-420147
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001954
Orphan claim re-pointed
Claims processor
CLM-432402 → UHC-35606-34 (Peter Marshall)
Member id
UHC-35606-34
Confidence
0.97
Method
deterministic
MBR-036642CLM-432402
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001955
Orphan claim re-pointed
Claims processor
CLM-418870 → UHC-43519-95 (Kathryn Duncan)
Member id
UHC-43519-95
Confidence
1
Method
probabilistic
MBR-027488CLM-418870
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001956
Orphan claim re-pointed
Claims processor
CLM-430446 → UHC-97803-20 (Mariana Cook)
Member id
UHC-97803-20
Confidence
0.94
Method
probabilistic
MBR-036927CLM-430446
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001957
Orphan claim re-pointed
Claims processor
CLM-408775 → UHC-29986-91 (Gary Jimenez)
Member id
UHC-29986-91
Confidence
0.97
Method
deterministic
MBR-011649CLM-408775
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001958
Orphan claim re-pointed
Claims processor
CLM-427701 → UHC-33223-95 (Katherine West)
Member id
UHC-33223-95
Confidence
0.97
Method
deterministic
MBR-003616CLM-427701
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001959
Orphan claim re-pointed
Claims processor
CLM-428353 → UHC-58395-71 (Keith Thompson)
Member id
UHC-58395-71
Confidence
1
Method
probabilistic
MBR-019688CLM-428353
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001960
Orphan claim re-pointed
Claims processor
CLM-432168 → UHC-83355-82 (Logan Morrison)
Member id
UHC-83355-82
Confidence
0.97
Method
deterministic
MBR-008544CLM-432168
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001961
Orphan claim re-pointed
Claims processor
CLM-400855 → UHC-59014-76 (Carol Porter)
Member id
UHC-59014-76
Confidence
0.99
Method
probabilistic
MBR-011662CLM-400855
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001962
Orphan claim re-pointed
Claims processor
CLM-404475 → UHC-81889-78 (Billy Barnes)
Member id
UHC-81889-78
Confidence
1
Method
probabilistic
MBR-002113CLM-404475
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001963
Orphan claim re-pointed
Claims processor
CLM-419618 → UHC-34568-51 (Aaron Berry)
Member id
UHC-34568-51
Confidence
1
Method
probabilistic
MBR-019637CLM-419618
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001964
Orphan claim re-pointed
Claims processor
CLM-406616 → UHC-14987-56 (Denise Henderson)
Member id
UHC-14987-56
Confidence
0.97
Method
deterministic
MBR-006940CLM-406616
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001965
Orphan claim re-pointed
Claims processor
CLM-407999 → UHC-72810-50 (Jean Watkins)
Member id
UHC-72810-50
Confidence
0.97
Method
deterministic
MBR-002548CLM-407999
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001966
Orphan claim re-pointed
Claims processor
CLM-405300 → UHC-47191-35 (Austin Valdez)
Member id
UHC-47191-35
Confidence
1
Method
probabilistic
MBR-032042CLM-405300
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001967
Orphan claim re-pointed
Claims processor
CLM-424148 → UHC-12380-01 (Angela Woods)
Member id
UHC-12380-01
Confidence
0.97
Method
probabilistic
MBR-002606CLM-424148
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001968
Orphan claim re-pointed
Claims processor
CLM-410133 → UHC-11547-97 (Andrew Little)
Member id
UHC-11547-97
Confidence
1
Method
probabilistic
MBR-018752CLM-410133
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001969
Orphan claim re-pointed
Claims processor
CLM-417074 → UHC-24476-29 (Hannah Williams)
Member id
UHC-24476-29
Confidence
1
Method
probabilistic
MBR-000004CLM-417074
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001970
Orphan claim re-pointed
Claims processor
CLM-426682 → UHC-46251-99 (Judith Larson)
Member id
UHC-46251-99
Confidence
0.99
Method
probabilistic
MBR-017317CLM-426682
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001971
Orphan claim re-pointed
Claims processor
CLM-415321 → UHC-06505-43 (Wayne Jackson)
Member id
UHC-06505-43
Confidence
1
Method
probabilistic
MBR-003709CLM-415321
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001972
Orphan claim re-pointed
Claims processor
CLM-410299 → UHC-33350-17 (Bruce Morris)
Member id
UHC-33350-17
Confidence
0.97
Method
deterministic
MBR-010105CLM-410299
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001973
Orphan claim re-pointed
Claims processor
CLM-412516 → UHC-63950-13 (Edward Guerrero)
Member id
UHC-63950-13
Confidence
0.99
Method
probabilistic
MBR-002641CLM-412516
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001974
Orphan claim re-pointed
Claims processor
CLM-415250 → UHC-20079-30 (Tyler Gomez)
Member id
UHC-20079-30
Confidence
1
Method
probabilistic
MBR-006161CLM-415250
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001975
Orphan claim re-pointed
Claims processor
CLM-429859 → UHC-19864-11 (Noah Tucker)
Member id
UHC-19864-11
Confidence
1
Method
probabilistic
MBR-007552CLM-429859
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001976
Orphan claim re-pointed
Claims processor
CLM-406518 → UHC-44206-31 (Sarah Hudson)
Member id
UHC-44206-31
Confidence
0.92
Method
probabilistic
MBR-026299CLM-406518
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001977
Orphan claim re-pointed
Claims processor
CLM-422405 → UHC-80915-35 (Mei Nunez)
Member id
UHC-80915-35
Confidence
0.97
Method
deterministic
MBR-031707CLM-422405
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001978
Orphan claim re-pointed
Claims processor
CLM-410608 → UHC-60515-86 (Mei Jones)
Member id
UHC-60515-86
Confidence
1
Method
probabilistic
MBR-017012CLM-410608
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001979
Orphan claim re-pointed
Claims processor
CLM-423976 → UHC-94658-36 (Luis Hunt)
Member id
UHC-94658-36
Confidence
0.93
Method
probabilistic
MBR-012557CLM-423976
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001980
Orphan claim re-pointed
Claims processor
CLM-421222 → UHC-45946-22 (Christian Butler)
Member id
UHC-45946-22
Confidence
1
Method
probabilistic
MBR-000949CLM-421222
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001981
Orphan claim re-pointed
Claims processor
CLM-431123 → UHC-06582-86 (Jacob Allen)
Member id
UHC-06582-86
Confidence
0.97
Method
deterministic
MBR-017061CLM-431123
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001982
Orphan claim re-pointed
Claims processor
CLM-431749 → UHC-00957-09 (Mari Tran)
Member id
UHC-00957-09
Confidence
1
Method
probabilistic
MBR-019574CLM-431749
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001983
Orphan claim re-pointed
Claims processor
CLM-428193 → UHC-40906-06 (Noah Soto)
Member id
UHC-40906-06
Confidence
1
Method
probabilistic
MBR-034498CLM-428193
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001984
Orphan claim re-pointed
Claims processor
CLM-423692 → UHC-53868-27 (Deborah Henderson)
Member id
UHC-53868-27
Confidence
1
Method
probabilistic
MBR-010482CLM-423692
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001985
Orphan claim re-pointed
Claims processor
CLM-420938 → UHC-74540-84 (Judith Soto)
Member id
UHC-74540-84
Confidence
0.99
Method
probabilistic
MBR-000244CLM-420938
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001986
Orphan claim re-pointed
Claims processor
CLM-432326 → UHC-53497-10 (Walter Alvarez)
Member id
UHC-53497-10
Confidence
1
Method
probabilistic
MBR-019263CLM-432326
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001987
Orphan claim re-pointed
Claims processor
CLM-408454 → UHC-03826-60 (Margaret Hunter)
Member id
UHC-03826-60
Confidence
1
Method
probabilistic
MBR-000094CLM-408454
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001988
Orphan claim re-pointed
Claims processor
CLM-405593 → UHC-23703-76 (Catherine Morrison)
Member id
UHC-23703-76
Confidence
0.93
Method
probabilistic
MBR-004566CLM-405593
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001989
Orphan claim re-pointed
Claims processor
CLM-421711 → UHC-84006-39 (Laura Ellis)
Member id
UHC-84006-39
Confidence
0.99
Method
probabilistic
MBR-015707CLM-421711
Executed
resolution_agent
2026-10-19 19:54:39
14,086 rows, page 13 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.