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-008390
Orphan claim re-pointed
Claims processor
CLM-407512 → UHC-03885-49 (Larry Walker)
Member id
UHC-03885-49
Confidence
1
Method
probabilistic
MBR-042383CLM-407512
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008391
Orphan claim re-pointed
Claims processor
CLM-406448 → UHC-14837-83 (Heather Estrada)
Member id
UHC-14837-83
Confidence
1
Method
probabilistic
MBR-031240CLM-406448
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008392
Orphan claim re-pointed
Claims processor
CLM-410757 → UHC-87313-66 (Shirley Armstrong)
Member id
UHC-87313-66
Confidence
1
Method
probabilistic
MBR-000193CLM-410757
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008393
Orphan claim re-pointed
Claims processor
CLM-431425 → UHC-19387-98 (Marcus Cook)
Member id
UHC-19387-98
Confidence
1
Method
probabilistic
MBR-002748CLM-431425
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008394
Orphan claim re-pointed
Claims processor
CLM-412805 → UHC-97157-40 (Brittany Hernandez)
Member id
UHC-97157-40
Confidence
0.99
Method
probabilistic
MBR-020669CLM-412805
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008395
Orphan claim re-pointed
Claims processor
CLM-431839 → UHC-59847-77 (Mason Mason)
Member id
UHC-59847-77
Confidence
0.97
Method
deterministic
MBR-027102CLM-431839
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008396
Orphan claim re-pointed
Claims processor
CLM-426001 → UHC-96758-59 (Jason Price)
Member id
UHC-96758-59
Confidence
0.97
Method
deterministic
MBR-000456CLM-426001
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008397
Orphan claim re-pointed
Claims processor
CLM-400040 → UHC-74188-59 (Logan Knight)
Member id
UHC-74188-59
Confidence
0.97
Method
deterministic
MBR-015189CLM-400040
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008398
Orphan claim re-pointed
Claims processor
CLM-409122 → UHC-55015-60 (Omar Green)
Member id
UHC-55015-60
Confidence
0.97
Method
deterministic
MBR-034719CLM-409122
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008399
Orphan claim re-pointed
Claims processor
CLM-416449 → UHC-83645-72 (Ruth Peterson)
Member id
UHC-83645-72
Confidence
1
Method
probabilistic
MBR-022862CLM-416449
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008400
Orphan claim re-pointed
Claims processor
CLM-427457 → UHC-15113-79 (Steve Wallace)
Member id
UHC-15113-79
Confidence
1
Method
probabilistic
MBR-035405CLM-427457
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008401
Orphan claim re-pointed
Claims processor
CLM-415894 → UHC-36112-57 (Diego Lane)
Member id
UHC-36112-57
Confidence
1
Method
probabilistic
MBR-005983CLM-415894
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008402
Orphan claim re-pointed
Claims processor
CLM-420824 → UHC-93150-43 (George Foster)
Member id
UHC-93150-43
Confidence
1
Method
probabilistic
MBR-007737CLM-420824
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008403
Orphan claim re-pointed
Claims processor
CLM-411784 → UHC-42370-87 (Barbara Yang)
Member id
UHC-42370-87
Confidence
0.93
Method
probabilistic
MBR-011371CLM-411784
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008404
Orphan claim re-pointed
Claims processor
CLM-402951 → UHC-52045-15 (Linda Garrett)
Member id
UHC-52045-15
Confidence
0.97
Method
deterministic
MBR-001868CLM-402951
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008405
Orphan claim re-pointed
Claims processor
CLM-415971 → UHC-67865-24 (Jennifer Hayes)
Member id
UHC-67865-24
Confidence
0.97
Method
deterministic
MBR-019439CLM-415971
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008406
Orphan claim re-pointed
Claims processor
CLM-401988 → UHC-78063-85 (Eugene McCoy)
Member id
UHC-78063-85
Confidence
1
Method
probabilistic
MBR-007036CLM-401988
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008407
Orphan claim re-pointed
Claims processor
CLM-414303 → UHC-60314-10 (Kathleen Knight)
Member id
UHC-60314-10
Confidence
1
Method
probabilistic
MBR-030239CLM-414303
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008408
Orphan claim re-pointed
Claims processor
CLM-406806 → UHC-97214-71 (Patricia Hart)
Member id
UHC-97214-71
Confidence
0.94
Method
probabilistic
MBR-034096CLM-406806
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008409
Orphan claim re-pointed
Claims processor
CLM-410580 → UHC-16606-32 (Jack Henderson)
Member id
UHC-16606-32
Confidence
1
Method
probabilistic
MBR-013858CLM-410580
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008410
Orphan claim re-pointed
Claims processor
CLM-426305 → UHC-48314-07 (Kathryn Munoz)
Member id
UHC-48314-07
Confidence
1
Method
probabilistic
MBR-026311CLM-426305
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008411
Orphan claim re-pointed
Claims processor
CLM-418161 → UHC-41583-44 (Joseph Wong)
Member id
UHC-41583-44
Confidence
1
Method
probabilistic
MBR-007289CLM-418161
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008412
Orphan claim re-pointed
Claims processor
CLM-413300 → UHC-20506-45 (Teresa Ford)
Member id
UHC-20506-45
Confidence
1
Method
probabilistic
MBR-015307CLM-413300
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008413
Orphan claim re-pointed
Claims processor
CLM-426858 → UHC-27905-48 (Sofia Ramos)
Member id
UHC-27905-48
Confidence
0.97
Method
deterministic
MBR-039327CLM-426858
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008414
Orphan claim re-pointed
Claims processor
CLM-420647 → UHC-69144-34 (Ralph Nichols)
Member id
UHC-69144-34
Confidence
1
Method
probabilistic
MBR-004093CLM-420647
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008415
Orphan claim re-pointed
Claims processor
CLM-411668 → UHC-34779-09 (Jack Fox)
Member id
UHC-34779-09
Confidence
1
Method
probabilistic
MBR-016851CLM-411668
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008416
Orphan claim re-pointed
Claims processor
CLM-406857 → UHC-38256-64 (Thomas Sandoval)
Member id
UHC-38256-64
Confidence
1
Method
probabilistic
MBR-025915CLM-406857
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008417
Orphan claim re-pointed
Claims processor
CLM-419523 → UHC-85777-05 (Peter Castillo)
Member id
UHC-85777-05
Confidence
1
Method
probabilistic
MBR-000993CLM-419523
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008418
Orphan claim re-pointed
Claims processor
CLM-408622 → UHC-33957-43 (Kyle Vega)
Member id
UHC-33957-43
Confidence
1
Method
probabilistic
MBR-011634CLM-408622
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008419
Orphan claim re-pointed
Claims processor
CLM-426717 → UHC-34141-14 (Theresa Chavez)
Member id
UHC-34141-14
Confidence
0.97
Method
deterministic
MBR-012449CLM-426717
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008420
Orphan claim re-pointed
Claims processor
CLM-404443 → UHC-76520-73 (Sandra Kim)
Member id
UHC-76520-73
Confidence
0.97
Method
deterministic
MBR-000585CLM-404443
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008421
Orphan claim re-pointed
Claims processor
CLM-422574 → UHC-04297-64 (Samantha Reid)
Member id
UHC-04297-64
Confidence
1
Method
probabilistic
MBR-006491CLM-422574
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008422
Orphan claim re-pointed
Claims processor
CLM-414611 → UHC-55711-88 (Kathy Garrett)
Member id
UHC-55711-88
Confidence
0.97
Method
deterministic
MBR-023059CLM-414611
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008423
Orphan claim re-pointed
Claims processor
CLM-424559 → UHC-04038-37 (Kimberly Austin)
Member id
UHC-04038-37
Confidence
1
Method
probabilistic
MBR-002279CLM-424559
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008424
Orphan claim re-pointed
Claims processor
CLM-419268 → UHC-53669-74 (Bradley Powell)
Member id
UHC-53669-74
Confidence
0.94
Method
probabilistic
MBR-015857CLM-419268
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008425
Orphan claim re-pointed
Claims processor
CLM-417790 → UHC-80007-46 (Wayne Simpson)
Member id
UHC-80007-46
Confidence
1
Method
probabilistic
MBR-008791CLM-417790
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008426
Orphan claim re-pointed
Claims processor
CLM-420572 → UHC-12915-66 (Austin Matthews)
Member id
UHC-12915-66
Confidence
1
Method
probabilistic
MBR-007937CLM-420572
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008427
Orphan claim re-pointed
Claims processor
CLM-429567 → UHC-43400-99 (Alexis Armstrong)
Member id
UHC-43400-99
Confidence
1
Method
probabilistic
MBR-000445CLM-429567
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008428
Orphan claim re-pointed
Claims processor
CLM-431955 → UHC-19650-15 (Bevery Lane)
Member id
UHC-19650-15
Confidence
0.99
Method
probabilistic
MBR-008566CLM-431955
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008429
Orphan claim re-pointed
Claims processor
CLM-431247 → UHC-13315-65 (Gregory Dean)
Member id
UHC-13315-65
Confidence
1
Method
probabilistic
MBR-006813CLM-431247
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008430
Orphan claim re-pointed
Claims processor
CLM-432651 → UHC-35610-05 (Ommar Brown)
Member id
UHC-35610-05
Confidence
0.99
Method
probabilistic
MBR-036511CLM-432651
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008431
Orphan claim re-pointed
Claims processor
CLM-423427 → UHC-26304-24 (Ralph Knight)
Member id
UHC-26304-24
Confidence
1
Method
probabilistic
MBR-005177CLM-423427
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008432
Orphan claim re-pointed
Claims processor
CLM-409165 → UHC-80089-58 (Juan Murphy)
Member id
UHC-80089-58
Confidence
1
Method
probabilistic
MBR-016812CLM-409165
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008433
Orphan claim re-pointed
Claims processor
CLM-427974 → UHC-05006-39 (Christopher Obrien)
Member id
UHC-05006-39
Confidence
0.99
Method
probabilistic
MBR-019906CLM-427974
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008434
Orphan claim re-pointed
Claims processor
CLM-407763 → UHC-02209-49 (Heather Hansen)
Member id
UHC-02209-49
Confidence
0.97
Method
deterministic
MBR-030647CLM-407763
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008435
Orphan claim re-pointed
Claims processor
CLM-417523 → UHC-33844-49 (Michelle Green)
Member id
UHC-33844-49
Confidence
1
Method
probabilistic
MBR-035846CLM-417523
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008436
Orphan claim re-pointed
Claims processor
CLM-419627 → UHC-32260-32 (Timothy Perry)
Member id
UHC-32260-32
Confidence
1
Method
probabilistic
MBR-020133CLM-419627
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008437
Orphan claim re-pointed
Claims processor
CLM-411561 → UHC-15893-43 (Hannah Andrews)
Member id
UHC-15893-43
Confidence
0.93
Method
probabilistic
MBR-043515CLM-411561
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008438
Orphan claim re-pointed
Claims processor
CLM-406776 → UHC-24250-02 (Carl Owens)
Member id
UHC-24250-02
Confidence
1
Method
probabilistic
MBR-006677CLM-406776
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008439
Orphan claim re-pointed
Claims processor
CLM-403519 → UHC-13349-08 (Pamela Thompson)
Member id
UHC-13349-08
Confidence
0.90
Method
probabilistic
MBR-019841CLM-403519
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 142 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.