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-002140
Orphan claim re-pointed
Claims processor
CLM-422674 → UHC-21918-10 (Kathryn Wheeler)
Member id
UHC-21918-10
Confidence
0.99
Method
probabilistic
MBR-028558CLM-422674
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002141
Orphan claim re-pointed
Claims processor
CLM-421679 → UHC-45856-82 (Yuki Gonzales)
Member id
UHC-45856-82
Confidence
0.99
Method
probabilistic
MBR-012021CLM-421679
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002142
Orphan claim re-pointed
Claims processor
CLM-406930 → UHC-22861-84 (Rebecca Harrison)
Member id
UHC-22861-84
Confidence
0.97
Method
deterministic
MBR-029028CLM-406930
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002143
Orphan claim re-pointed
Claims processor
CLM-405611 → UHC-44784-71 (Mariana Lane)
Member id
UHC-44784-71
Confidence
0.93
Method
probabilistic
MBR-033874CLM-405611
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002144
Orphan claim re-pointed
Claims processor
CLM-413806 → UHC-34240-65 (Willie Robinson)
Member id
UHC-34240-65
Confidence
1
Method
probabilistic
MBR-023528CLM-413806
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002145
Orphan claim re-pointed
Claims processor
CLM-415856 → UHC-00613-40 (Tyler Snyder)
Member id
UHC-00613-40
Confidence
1
Method
probabilistic
MBR-002708CLM-415856
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002146
Orphan claim re-pointed
Claims processor
CLM-423949 → UHC-91976-08 (Raymond Woods)
Member id
UHC-91976-08
Confidence
1
Method
probabilistic
MBR-027311CLM-423949
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002147
Orphan claim re-pointed
Claims processor
CLM-408658 → UHC-37053-26 (Priya Williamson)
Member id
UHC-37053-26
Confidence
1
Method
probabilistic
MBR-027739CLM-408658
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002148
Orphan claim re-pointed
Claims processor
CLM-417777 → UHC-35103-42 (Henry Hudson)
Member id
UHC-35103-42
Confidence
0.97
Method
deterministic
MBR-001301CLM-417777
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002149
Orphan claim re-pointed
Claims processor
CLM-411149 → UHC-28541-33 (Noah Burns)
Member id
UHC-28541-33
Confidence
0.94
Method
probabilistic
MBR-009217CLM-411149
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002150
Orphan claim re-pointed
Claims processor
CLM-421900 → UHC-80433-48 (Alexis Price)
Member id
UHC-80433-48
Confidence
1
Method
probabilistic
MBR-025040CLM-421900
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002151
Orphan claim re-pointed
Claims processor
CLM-425354 → UHC-10902-28 (Mason Edwards)
Member id
UHC-10902-28
Confidence
1
Method
probabilistic
MBR-024072CLM-425354
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002152
Orphan claim re-pointed
Claims processor
CLM-404698 → UHC-76713-41 (Brenda Stephens)
Member id
UHC-76713-41
Confidence
1
Method
probabilistic
MBR-004014CLM-404698
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002153
Orphan claim re-pointed
Claims processor
CLM-429948 → UHC-28727-85 (Frances Hansen)
Member id
UHC-28727-85
Confidence
1
Method
probabilistic
MBR-024524CLM-429948
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002154
Orphan claim re-pointed
Claims processor
CLM-407591 → UHC-56547-09 (Elizabeth Kelley)
Member id
UHC-56547-09
Confidence
0.97
Method
deterministic
MBR-000488CLM-407591
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002155
Orphan claim re-pointed
Claims processor
CLM-414088 → UHC-63894-92 (Tyler Adams)
Member id
UHC-63894-92
Confidence
1
Method
probabilistic
MBR-009269CLM-414088
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002156
Orphan claim re-pointed
Claims processor
CLM-431075 → UHC-00720-73 (Brenda Carpenter)
Member id
UHC-00720-73
Confidence
1
Method
probabilistic
MBR-025314CLM-431075
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002157
Orphan claim re-pointed
Claims processor
CLM-409618 → UHC-70330-92 (Albert Hayes)
Member id
UHC-70330-92
Confidence
0.98
Method
probabilistic
MBR-011061CLM-409618
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002158
Orphan claim re-pointed
Claims processor
CLM-409575 → UHC-33964-15 (Heather Welch)
Member id
UHC-33964-15
Confidence
1
Method
probabilistic
MBR-037423CLM-409575
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002159
Orphan claim re-pointed
Claims processor
CLM-431505 → UHC-05977-75 (Chris Richards)
Member id
UHC-05977-75
Confidence
1
Method
probabilistic
MBR-039149CLM-431505
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002160
Orphan claim re-pointed
Claims processor
CLM-421866 → UHC-74984-66 (Nancy Wong)
Member id
UHC-74984-66
Confidence
0.97
Method
deterministic
MBR-014859CLM-421866
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002161
Orphan claim re-pointed
Claims processor
CLM-432287 → UHC-44700-43 (Denise Mills)
Member id
UHC-44700-43
Confidence
1
Method
probabilistic
MBR-026061CLM-432287
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002162
Orphan claim re-pointed
Claims processor
CLM-429323 → UHC-62701-47 (Jordan Robertson)
Member id
UHC-62701-47
Confidence
1
Method
probabilistic
MBR-032746CLM-429323
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002163
Orphan claim re-pointed
Claims processor
CLM-425453 → UHC-52419-70 (Scott Gibson)
Member id
UHC-52419-70
Confidence
1
Method
probabilistic
MBR-011596CLM-425453
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002164
Orphan claim re-pointed
Claims processor
CLM-414936 → UHC-40253-88 (Tyler Gray)
Member id
UHC-40253-88
Confidence
0.93
Method
probabilistic
MBR-030062CLM-414936
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002165
Orphan claim re-pointed
Claims processor
CLM-430762 → UHC-62292-08 (Zachary Baker)
Member id
UHC-62292-08
Confidence
1
Method
probabilistic
MBR-019270CLM-430762
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002166
Orphan claim re-pointed
Claims processor
CLM-426278 → UHC-34666-58 (Nancy Valdez)
Member id
UHC-34666-58
Confidence
1
Method
probabilistic
MBR-024644CLM-426278
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002167
Orphan claim re-pointed
Claims processor
CLM-401275 → UHC-69783-42 (Mark McDonald)
Member id
UHC-69783-42
Confidence
1
Method
probabilistic
MBR-007715CLM-401275
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002168
Orphan claim re-pointed
Claims processor
CLM-405796 → UHC-11088-69 (Jordan Duncan)
Member id
UHC-11088-69
Confidence
0.94
Method
probabilistic
MBR-006126CLM-405796
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002169
Orphan claim re-pointed
Claims processor
CLM-424277 → UHC-22202-05 (Deborah Vargas)
Member id
UHC-22202-05
Confidence
1
Method
probabilistic
MBR-013632CLM-424277
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002170
Orphan claim re-pointed
Claims processor
CLM-417558 → UHC-84776-24 (Denise Peterson)
Member id
UHC-84776-24
Confidence
1
Method
probabilistic
MBR-022187CLM-417558
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002171
Orphan claim re-pointed
Claims processor
CLM-431731 → UHC-88301-75 (Elizabeth Pierce)
Member id
UHC-88301-75
Confidence
1
Method
probabilistic
MBR-016008CLM-431731
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002172
Orphan claim re-pointed
Claims processor
CLM-404057 → UHC-88620-95 (Roger Watson)
Member id
UHC-88620-95
Confidence
0.98
Method
probabilistic
MBR-025823CLM-404057
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002173
Orphan claim re-pointed
Claims processor
CLM-409049 → UHC-45658-13 (Thomas Welch)
Member id
UHC-45658-13
Confidence
0.97
Method
deterministic
MBR-026980CLM-409049
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002174
Orphan claim re-pointed
Claims processor
CLM-404773 → UHC-89097-26 (Michael Nelson)
Member id
UHC-89097-26
Confidence
0.97
Method
deterministic
MBR-002528CLM-404773
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002175
Orphan claim re-pointed
Claims processor
CLM-406927 → UHC-06484-78 (Matthew Castro)
Member id
UHC-06484-78
Confidence
0.97
Method
deterministic
MBR-023160CLM-406927
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002176
Orphan claim re-pointed
Claims processor
CLM-409589 → UHC-00556-15 (Adam Turner)
Member id
UHC-00556-15
Confidence
0.97
Method
deterministic
MBR-025635CLM-409589
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002177
Orphan claim re-pointed
Claims processor
CLM-429562 → UHC-07193-28 (Stephanie Yang)
Member id
UHC-07193-28
Confidence
0.97
Method
deterministic
MBR-020171CLM-429562
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002178
Orphan claim re-pointed
Claims processor
CLM-426711 → UHC-10317-87 (Charles Morrison)
Member id
UHC-10317-87
Confidence
1
Method
probabilistic
MBR-022553CLM-426711
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002179
Orphan claim re-pointed
Claims processor
CLM-425856 → UHC-24843-71 (Priya Estrada)
Member id
UHC-24843-71
Confidence
1
Method
probabilistic
MBR-034361CLM-425856
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002180
Orphan claim re-pointed
Claims processor
CLM-412531 → UHC-77548-67 (Karen Wagner)
Member id
UHC-77548-67
Confidence
1
Method
probabilistic
MBR-016170CLM-412531
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002181
Orphan claim re-pointed
Claims processor
CLM-405950 → UHC-91434-86 (Joe Martin)
Member id
UHC-91434-86
Confidence
0.97
Method
deterministic
MBR-025261CLM-405950
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002182
Orphan claim re-pointed
Claims processor
CLM-410106 → UHC-56842-65 (Abigail Reynolds)
Member id
UHC-56842-65
Confidence
1
Method
probabilistic
MBR-011939CLM-410106
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002183
Orphan claim re-pointed
Claims processor
CLM-410400 → UHC-45904-17 (Ana Robinson)
Member id
UHC-45904-17
Confidence
0.97
Method
deterministic
MBR-020998CLM-410400
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002184
Orphan claim re-pointed
Claims processor
CLM-401676 → UHC-67952-09 (Brian Syder)
Member id
UHC-67952-09
Confidence
1
Method
probabilistic
MBR-019933CLM-401676
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002185
Orphan claim re-pointed
Claims processor
CLM-417217 → UHC-54423-95 (Katherine Murphy)
Member id
UHC-54423-95
Confidence
1
Method
probabilistic
MBR-041962CLM-417217
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002186
Orphan claim re-pointed
Claims processor
CLM-427376 → UHC-37268-78 (Ana Cox)
Member id
UHC-37268-78
Confidence
0.97
Method
deterministic
MBR-029154CLM-427376
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002187
Orphan claim re-pointed
Claims processor
CLM-404333 → UHC-41797-44 (Sharon Miller)
Member id
UHC-41797-44
Confidence
1
Method
probabilistic
MBR-007349CLM-404333
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002188
Orphan claim re-pointed
Claims processor
CLM-414107 → UHC-60096-29 (Water Estrada)
Member id
UHC-60096-29
Confidence
0.99
Method
probabilistic
MBR-000838CLM-414107
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002189
Orphan claim re-pointed
Claims processor
CLM-425604 → UHC-75343-29 (Lauren Wang)
Member id
UHC-75343-29
Confidence
1
Method
probabilistic
MBR-000146CLM-425604
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 17 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.