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-009640
Orphan claim re-pointed
Claims processor
CLM-402903 → UHC-84406-53 (Alexander Contreras)
Member id
UHC-84406-53
Confidence
1
Method
probabilistic
MBR-002419CLM-402903
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009641
Orphan claim re-pointed
Claims processor
CLM-427056 → UHC-73279-07 (Santiago Collins)
Member id
UHC-73279-07
Confidence
0.97
Method
deterministic
MBR-032146CLM-427056
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009642
Orphan claim re-pointed
Claims processor
CLM-406250 → UHC-02773-73 (Martha Rodriguez)
Member id
UHC-02773-73
Confidence
0.97
Method
deterministic
MBR-000708CLM-406250
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009643
Orphan claim re-pointed
Claims processor
CLM-405350 → UHC-50320-21 (Ana Bailey)
Member id
UHC-50320-21
Confidence
0.97
Method
deterministic
MBR-014435CLM-405350
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009644
Orphan claim re-pointed
Claims processor
CLM-425888 → UHC-90277-38 (Randy Edwards)
Member id
UHC-90277-38
Confidence
1
Method
probabilistic
MBR-013522CLM-425888
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009645
Orphan claim re-pointed
Claims processor
CLM-417736 → UHC-05335-91 (Wayne Castro)
Member id
UHC-05335-91
Confidence
0.97
Method
deterministic
MBR-009948CLM-417736
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009646
Orphan claim re-pointed
Claims processor
CLM-427729 → UHC-06478-92 (Alexander Smith)
Member id
UHC-06478-92
Confidence
0.99
Method
probabilistic
MBR-024489CLM-427729
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009647
Orphan claim re-pointed
Claims processor
CLM-418747 → UHC-00279-10 (Brittany Lucas)
Member id
UHC-00279-10
Confidence
0.98
Method
probabilistic
MBR-017816CLM-418747
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009648
Orphan claim re-pointed
Claims processor
CLM-406437 → UHC-33550-60 (Wei Nelson)
Member id
UHC-33550-60
Confidence
1
Method
probabilistic
MBR-020362CLM-406437
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009649
Orphan claim re-pointed
Claims processor
CLM-406880 → UHC-12515-95 (Ana Gibson)
Member id
UHC-12515-95
Confidence
1
Method
probabilistic
MBR-009099CLM-406880
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009650
Orphan claim re-pointed
Claims processor
CLM-417082 → UHC-29227-75 (Carolyn Sanchez)
Member id
UHC-29227-75
Confidence
1
Method
probabilistic
MBR-007385CLM-417082
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009651
Orphan claim re-pointed
Claims processor
CLM-407467 → UHC-13189-31 (Vincent Adams)
Member id
UHC-13189-31
Confidence
1
Method
probabilistic
MBR-035000CLM-407467
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009652
Orphan claim re-pointed
Claims processor
CLM-428481 → UHC-75505-45 (Keith Graham)
Member id
UHC-75505-45
Confidence
0.97
Method
deterministic
MBR-004957CLM-428481
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009653
Orphan claim re-pointed
Claims processor
CLM-422330 → UHC-52550-77 (Charles Cook)
Member id
UHC-52550-77
Confidence
0.97
Method
deterministic
MBR-015086CLM-422330
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009654
Orphan claim re-pointed
Claims processor
CLM-406382 → UHC-91130-49 (Vincent Jenkins)
Member id
UHC-91130-49
Confidence
1
Method
probabilistic
MBR-028379CLM-406382
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009655
Orphan claim re-pointed
Claims processor
CLM-403085 → UHC-61741-31 (Charlotte Rogers)
Member id
UHC-61741-31
Confidence
1
Method
probabilistic
MBR-015116CLM-403085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009656
Orphan claim re-pointed
Claims processor
CLM-420523 → UHC-80996-85 (Denise Ramos)
Member id
UHC-80996-85
Confidence
1
Method
probabilistic
MBR-003840CLM-420523
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009657
Orphan claim re-pointed
Claims processor
CLM-420771 → UHC-57626-40 (Jonathan Marquez)
Member id
UHC-57626-40
Confidence
0.97
Method
deterministic
MBR-043712CLM-420771
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009658
Orphan claim re-pointed
Claims processor
CLM-405783 → UHC-59682-46 (Doris Robertson)
Member id
UHC-59682-46
Confidence
1
Method
probabilistic
MBR-006165CLM-405783
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009659
Orphan claim re-pointed
Claims processor
CLM-431960 → UHC-03242-36 (Ralph Andrews)
Member id
UHC-03242-36
Confidence
1
Method
probabilistic
MBR-007960CLM-431960
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009660
Orphan claim re-pointed
Claims processor
CLM-428694 → UHC-92720-51 (Lucia Rios)
Member id
UHC-92720-51
Confidence
1
Method
probabilistic
MBR-006680CLM-428694
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009661
Orphan claim re-pointed
Claims processor
CLM-429793 → UHC-26263-45 (Jeremy Moore)
Member id
UHC-26263-45
Confidence
1
Method
probabilistic
MBR-000239CLM-429793
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009662
Orphan claim re-pointed
Claims processor
CLM-432088 → UHC-15097-94 (Bruce Collins)
Member id
UHC-15097-94
Confidence
1
Method
probabilistic
MBR-023076CLM-432088
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009663
Orphan claim re-pointed
Claims processor
CLM-432092 → UHC-20902-13 (Samantha Fuller)
Member id
UHC-20902-13
Confidence
1
Method
probabilistic
MBR-011008CLM-432092
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009664
Orphan claim re-pointed
Claims processor
CLM-413788 → UHC-01066-48 (Alice Baker)
Member id
UHC-01066-48
Confidence
1
Method
probabilistic
MBR-002944CLM-413788
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009665
Orphan claim re-pointed
Claims processor
CLM-417620 → UHC-21667-70 (Logan Daniels)
Member id
UHC-21667-70
Confidence
1
Method
probabilistic
MBR-041318CLM-417620
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009666
Orphan claim re-pointed
Claims processor
CLM-411132 → UHC-39221-56 (Lori Garcia)
Member id
UHC-39221-56
Confidence
1
Method
probabilistic
MBR-012451CLM-411132
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009667
Orphan claim re-pointed
Claims processor
CLM-429543 → UHC-90001-13 (Omar Boyd)
Member id
UHC-90001-13
Confidence
1
Method
probabilistic
MBR-027759CLM-429543
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009668
Orphan claim re-pointed
Claims processor
CLM-413003 → UHC-54709-71 (Mateo Barnes)
Member id
UHC-54709-71
Confidence
0.97
Method
deterministic
MBR-012219CLM-413003
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009669
Orphan claim re-pointed
Claims processor
CLM-405133 → UHC-08142-79 (Richard Silva)
Member id
UHC-08142-79
Confidence
1.00
Method
probabilistic
MBR-011684CLM-405133
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009670
Orphan claim re-pointed
Claims processor
CLM-406631 → UHC-27982-32 (Lori Lane)
Member id
UHC-27982-32
Confidence
1
Method
probabilistic
MBR-010158CLM-406631
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009671
Orphan claim re-pointed
Claims processor
CLM-424887 → UHC-92295-16 (Joyce Hunter)
Member id
UHC-92295-16
Confidence
1
Method
probabilistic
MBR-013433CLM-424887
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009672
Orphan claim re-pointed
Claims processor
CLM-419046 → UHC-44964-27 (Peter Parker)
Member id
UHC-44964-27
Confidence
0.97
Method
deterministic
MBR-039414CLM-419046
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009673
Orphan claim re-pointed
Claims processor
CLM-422180 → UHC-18366-77 (Evelyn Graham)
Member id
UHC-18366-77
Confidence
0.93
Method
probabilistic
MBR-005585CLM-422180
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009674
Orphan claim re-pointed
Claims processor
CLM-429609 → UHC-30744-33 (Elizabeth Stone)
Member id
UHC-30744-33
Confidence
1
Method
probabilistic
MBR-036167CLM-429609
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009675
Orphan claim re-pointed
Claims processor
CLM-416896 → UHC-68238-77 (Carol Hall)
Member id
UHC-68238-77
Confidence
0.99
Method
probabilistic
MBR-011289CLM-416896
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009676
Orphan claim re-pointed
Claims processor
CLM-403901 → UHC-83339-71 (Sofia Greene)
Member id
UHC-83339-71
Confidence
1
Method
probabilistic
MBR-000537CLM-403901
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009677
Orphan claim re-pointed
Claims processor
CLM-413551 → UHC-46841-03 (Rachel Richardson)
Member id
UHC-46841-03
Confidence
1
Method
probabilistic
MBR-020287CLM-413551
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009678
Orphan claim re-pointed
Claims processor
CLM-406707 → UHC-78584-61 (Adams Frank)
Member id
UHC-78584-61
Confidence
0.98
Method
probabilistic
MBR-042039CLM-406707
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009679
Orphan claim re-pointed
Claims processor
CLM-427703 → UHC-85622-08 (Jacqueline Mitchell)
Member id
UHC-85622-08
Confidence
1
Method
probabilistic
MBR-016059CLM-427703
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009680
Orphan claim re-pointed
Claims processor
CLM-420076 → UHC-29692-11 (Laura Cooper)
Member id
UHC-29692-11
Confidence
1
Method
probabilistic
MBR-012501CLM-420076
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009681
Orphan claim re-pointed
Claims processor
CLM-424208 → UHC-53662-77 (Linda Wong)
Member id
UHC-53662-77
Confidence
1
Method
probabilistic
MBR-013676CLM-424208
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009682
Orphan claim re-pointed
Claims processor
CLM-432802 → UHC-67388-37 (Eugene Graham)
Member id
UHC-67388-37
Confidence
1
Method
probabilistic
MBR-031449CLM-432802
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009683
Orphan claim re-pointed
Claims processor
CLM-421463 → UHC-66715-60 (Denise Arnold)
Member id
UHC-66715-60
Confidence
1
Method
probabilistic
MBR-025291CLM-421463
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009684
Orphan claim re-pointed
Claims processor
CLM-422229 → UHC-14730-39 (Gerald Hicks)
Member id
UHC-14730-39
Confidence
0.99
Method
probabilistic
MBR-017162CLM-422229
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009685
Orphan claim re-pointed
Claims processor
CLM-412878 → UHC-62480-15 (Barbara Vazquez)
Member id
UHC-62480-15
Confidence
0.97
Method
deterministic
MBR-042201CLM-412878
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009686
Orphan claim re-pointed
Claims processor
CLM-412152 → UHC-61614-87 (Sandra Estrada)
Member id
UHC-61614-87
Confidence
1
Method
probabilistic
MBR-013386CLM-412152
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009687
Orphan claim re-pointed
Claims processor
CLM-404299 → UHC-66632-26 (Randy Snyder)
Member id
UHC-66632-26
Confidence
1
Method
probabilistic
MBR-038978CLM-404299
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009688
Orphan claim re-pointed
Claims processor
CLM-415507 → UHC-27166-87 (Cheryl Hoffman)
Member id
UHC-27166-87
Confidence
1
Method
probabilistic
MBR-018641CLM-415507
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009689
Orphan claim re-pointed
Claims processor
CLM-406044 → UHC-05239-58 (Nicole Sullivan)
Member id
UHC-05239-58
Confidence
1
Method
probabilistic
MBR-029680CLM-406044
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 167 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.