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-009540
Orphan claim re-pointed
Claims processor
CLM-426058 → UHC-29564-55 (Carol Arnold)
Member id
UHC-29564-55
Confidence
1
Method
probabilistic
MBR-006224CLM-426058
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009541
Orphan claim re-pointed
Claims processor
CLM-411152 → UHC-10284-69 (Megan Burke)
Member id
UHC-10284-69
Confidence
0.97
Method
deterministic
MBR-033441CLM-411152
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009542
Orphan claim re-pointed
Claims processor
CLM-428800 → UHC-17958-15 (Hiroshi Shaw)
Member id
UHC-17958-15
Confidence
0.97
Method
deterministic
MBR-015681CLM-428800
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009543
Orphan claim re-pointed
Claims processor
CLM-423978 → UHC-23564-09 (Kimberly Dominguez)
Member id
UHC-23564-09
Confidence
1
Method
probabilistic
MBR-004737CLM-423978
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009544
Orphan claim re-pointed
Claims processor
CLM-428327 → UHC-92262-47 (Valentina Greene)
Member id
UHC-92262-47
Confidence
1
Method
probabilistic
MBR-037961CLM-428327
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009545
Orphan claim re-pointed
Claims processor
CLM-420156 → UHC-63388-86 (Theresa Tucker)
Member id
UHC-63388-86
Confidence
0.94
Method
probabilistic
MBR-019489CLM-420156
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009546
Orphan claim re-pointed
Claims processor
CLM-419530 → UHC-16662-97 (Ashley Munoz)
Member id
UHC-16662-97
Confidence
1
Method
probabilistic
MBR-006139CLM-419530
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009547
Orphan claim re-pointed
Claims processor
CLM-403332 → UHC-81477-97 (Teresa Hayes)
Member id
UHC-81477-97
Confidence
1
Method
probabilistic
MBR-012681CLM-403332
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009548
Orphan claim re-pointed
Claims processor
CLM-411655 → UHC-19399-24 (Ann Williamson)
Member id
UHC-19399-24
Confidence
1
Method
probabilistic
MBR-005080CLM-411655
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009549
Orphan claim re-pointed
Claims processor
CLM-409473 → UHC-58278-39 (Douglas Robinson)
Member id
UHC-58278-39
Confidence
1
Method
probabilistic
MBR-020061CLM-409473
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009550
Orphan claim re-pointed
Claims processor
CLM-410056 → UHC-99251-17 (Randy Mason)
Member id
UHC-99251-17
Confidence
0.97
Method
deterministic
MBR-030737CLM-410056
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009551
Orphan claim re-pointed
Claims processor
CLM-404594 → UHC-13136-66 (Amber Mejia)
Member id
UHC-13136-66
Confidence
1
Method
probabilistic
MBR-017053CLM-404594
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009552
Orphan claim re-pointed
Claims processor
CLM-423159 → UHC-31409-02 (Ryan Soto)
Member id
UHC-31409-02
Confidence
1
Method
probabilistic
MBR-025104CLM-423159
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009553
Orphan claim re-pointed
Claims processor
CLM-414540 → UHC-56827-60 (Bobby Carroll)
Member id
UHC-56827-60
Confidence
0.97
Method
deterministic
MBR-024104CLM-414540
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009554
Orphan claim re-pointed
Claims processor
CLM-408276 → UHC-42995-06 (Debra Fuller)
Member id
UHC-42995-06
Confidence
1
Method
probabilistic
MBR-025528CLM-408276
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009555
Orphan claim re-pointed
Claims processor
CLM-423794 → UHC-39955-17 (Samantha Reid)
Member id
UHC-39955-17
Confidence
1
Method
probabilistic
MBR-005939CLM-423794
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009556
Orphan claim re-pointed
Claims processor
CLM-425927 → UHC-21896-71 (Benjamin Brown)
Member id
UHC-21896-71
Confidence
0.97
Method
deterministic
MBR-013190CLM-425927
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009557
Orphan claim re-pointed
Claims processor
CLM-418598 → UHC-26249-22 (Henry Daniels)
Member id
UHC-26249-22
Confidence
0.99
Method
probabilistic
MBR-016105CLM-418598
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009558
Orphan claim re-pointed
Claims processor
CLM-417709 → UHC-65636-63 (Noah James)
Member id
UHC-65636-63
Confidence
1
Method
probabilistic
MBR-030355CLM-417709
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009559
Orphan claim re-pointed
Claims processor
CLM-400162 → UHC-59351-27 (Cynthia Peterson)
Member id
UHC-59351-27
Confidence
1
Method
probabilistic
MBR-032047CLM-400162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009560
Orphan claim re-pointed
Claims processor
CLM-416666 → UHC-82604-10 (Andrea Lawson)
Member id
UHC-82604-10
Confidence
1
Method
probabilistic
MBR-007026CLM-416666
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009561
Orphan claim re-pointed
Claims processor
CLM-412565 → UHC-31114-80 (Kathleen Lane)
Member id
UHC-31114-80
Confidence
1
Method
probabilistic
MBR-008165CLM-412565
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009562
Orphan claim re-pointed
Claims processor
CLM-415696 → UHC-13174-98 (Judy Burns)
Member id
UHC-13174-98
Confidence
1
Method
probabilistic
MBR-007661CLM-415696
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009563
Orphan claim re-pointed
Claims processor
CLM-430298 → UHC-61149-15 (Alexander Snyder)
Member id
UHC-61149-15
Confidence
1
Method
probabilistic
MBR-007090CLM-430298
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009564
Orphan claim re-pointed
Claims processor
CLM-429430 → UHC-40897-12 (Dorothy Collins)
Member id
UHC-40897-12
Confidence
1
Method
probabilistic
MBR-025529CLM-429430
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009565
Orphan claim re-pointed
Claims processor
CLM-409083 → UHC-61419-84 (Kathryn Knight)
Member id
UHC-61419-84
Confidence
1
Method
probabilistic
MBR-013145CLM-409083
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009566
Orphan claim re-pointed
Claims processor
CLM-407940 → UHC-60762-21 (Donald Castro)
Member id
UHC-60762-21
Confidence
1
Method
probabilistic
MBR-021067CLM-407940
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009567
Orphan claim re-pointed
Claims processor
CLM-408812 → UHC-12996-17 (Mary Burton)
Member id
UHC-12996-17
Confidence
0.97
Method
deterministic
MBR-034232CLM-408812
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009568
Orphan claim re-pointed
Claims processor
CLM-422379 → UHC-45736-97 (David Hicks)
Member id
UHC-45736-97
Confidence
1
Method
probabilistic
MBR-010523CLM-422379
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009569
Orphan claim re-pointed
Claims processor
CLM-402232 → UHC-11287-52 (Stephanie Harvey)
Member id
UHC-11287-52
Confidence
0.87
Method
probabilistic
MBR-033790CLM-402232
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009570
Orphan claim re-pointed
Claims processor
CLM-426634 → UHC-62320-38 (Barbara Cooper)
Member id
UHC-62320-38
Confidence
1
Method
probabilistic
MBR-012284CLM-426634
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009571
Orphan claim re-pointed
Claims processor
CLM-431165 → UHC-21829-60 (Rachel Walker)
Member id
UHC-21829-60
Confidence
0.93
Method
probabilistic
MBR-026510CLM-431165
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009572
Orphan claim re-pointed
Claims processor
CLM-423935 → UHC-37895-83 (Kenneth Johnston)
Member id
UHC-37895-83
Confidence
1
Method
probabilistic
MBR-015283CLM-423935
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009573
Orphan claim re-pointed
Claims processor
CLM-409683 → UHC-58749-30 (Alice Foster)
Member id
UHC-58749-30
Confidence
0.99
Method
probabilistic
MBR-017030CLM-409683
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009574
Orphan claim re-pointed
Claims processor
CLM-406514 → UHC-58654-72 (Virginia Berry)
Member id
UHC-58654-72
Confidence
1
Method
probabilistic
MBR-015241CLM-406514
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009575
Orphan claim re-pointed
Claims processor
CLM-414254 → UHC-23742-38 (Brittany Romero)
Member id
UHC-23742-38
Confidence
1
Method
probabilistic
MBR-027504CLM-414254
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009576
Orphan claim re-pointed
Claims processor
CLM-414509 → UHC-70261-24 (Samuel Guerrero)
Member id
UHC-70261-24
Confidence
1
Method
probabilistic
MBR-001242CLM-414509
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009577
Orphan claim re-pointed
Claims processor
CLM-420557 → UHC-21260-01 (Natalie Moore)
Member id
UHC-21260-01
Confidence
1
Method
probabilistic
MBR-028343CLM-420557
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009578
Orphan claim re-pointed
Claims processor
CLM-402348 → UHC-68685-92 (Mary Allen)
Member id
UHC-68685-92
Confidence
0.97
Method
probabilistic
MBR-002549CLM-402348
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009579
Orphan claim re-pointed
Claims processor
CLM-431419 → UHC-90045-65 (Joan Elliott)
Member id
UHC-90045-65
Confidence
1
Method
probabilistic
MBR-016189CLM-431419
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009580
Orphan claim re-pointed
Claims processor
CLM-418988 → UHC-44369-43 (Sophia Rogers)
Member id
UHC-44369-43
Confidence
0.97
Method
deterministic
MBR-028751CLM-418988
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009581
Orphan claim re-pointed
Claims processor
CLM-412064 → UHC-55338-16 (Kathryn Salazar)
Member id
UHC-55338-16
Confidence
0.97
Method
deterministic
MBR-022992CLM-412064
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009582
Orphan claim re-pointed
Claims processor
CLM-405026 → UHC-16902-14 (Christine Kelly)
Member id
UHC-16902-14
Confidence
0.94
Method
probabilistic
MBR-019123CLM-405026
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009583
Orphan claim re-pointed
Claims processor
CLM-411262 → UHC-28602-56 (Adam Bailey)
Member id
UHC-28602-56
Confidence
1
Method
probabilistic
MBR-007492CLM-411262
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009584
Orphan claim re-pointed
Claims processor
CLM-425274 → UHC-27517-35 (Randy Ortiz)
Member id
UHC-27517-35
Confidence
1
Method
probabilistic
MBR-005299CLM-425274
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009585
Orphan claim re-pointed
Claims processor
CLM-419031 → UHC-09498-69 (Stephanie Long)
Member id
UHC-09498-69
Confidence
0.99
Method
probabilistic
MBR-030711CLM-419031
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009586
Orphan claim re-pointed
Claims processor
CLM-422483 → UHC-65025-01 (Bobby Wilson)
Member id
UHC-65025-01
Confidence
1
Method
probabilistic
MBR-004716CLM-422483
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009587
Orphan claim re-pointed
Claims processor
CLM-418441 → UHC-18764-68 (Harrold Morrison)
Member id
UHC-18764-68
Confidence
0.99
Method
probabilistic
MBR-021674CLM-418441
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009588
Orphan claim re-pointed
Claims processor
CLM-402766 → UHC-54330-79 (Lori Santos)
Member id
UHC-54330-79
Confidence
1
Method
probabilistic
MBR-002566CLM-402766
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009589
Orphan claim re-pointed
Claims processor
CLM-420100 → UHC-20965-16 (Dorothy Greene)
Member id
UHC-20965-16
Confidence
1
Method
probabilistic
MBR-000287CLM-420100
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 165 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.