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-009790
Orphan claim re-pointed
Claims processor
CLM-425473 → UHC-33599-32 (Sean Young)
Member id
UHC-33599-32
Confidence
0.98
Method
probabilistic
MBR-024788CLM-425473
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009791
Orphan claim re-pointed
Claims processor
CLM-406195 → UHC-00138-75 (Fatima Perkins)
Member id
UHC-00138-75
Confidence
1
Method
probabilistic
MBR-002285CLM-406195
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009792
Orphan claim re-pointed
Claims processor
CLM-414610 → UHC-55711-88 (Kathy Garrett)
Member id
UHC-55711-88
Confidence
0.97
Method
deterministic
MBR-023059CLM-414610
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009793
Orphan claim re-pointed
Claims processor
CLM-430820 → UHC-68161-24 (Timothy Edwards)
Member id
UHC-68161-24
Confidence
1
Method
probabilistic
MBR-003875CLM-430820
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009794
Orphan claim re-pointed
Claims processor
CLM-430111 → UHC-01242-71 (Frank Yang)
Member id
UHC-01242-71
Confidence
1
Method
probabilistic
MBR-015607CLM-430111
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009795
Orphan claim re-pointed
Claims processor
CLM-418153 → UHC-63645-91 (Harold Mejia)
Member id
UHC-63645-91
Confidence
0.99
Method
probabilistic
MBR-009130CLM-418153
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009796
Orphan claim re-pointed
Claims processor
CLM-415041 → UHC-63870-54 (Ronald Evans)
Member id
UHC-63870-54
Confidence
0.97
Method
deterministic
MBR-017762CLM-415041
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009797
Orphan claim re-pointed
Claims processor
CLM-417230 → UHC-88955-23 (Andrea Anderson)
Member id
UHC-88955-23
Confidence
1
Method
probabilistic
MBR-018844CLM-417230
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009798
Orphan claim re-pointed
Claims processor
CLM-411622 → UHC-88620-39 (Brandon Park)
Member id
UHC-88620-39
Confidence
1
Method
probabilistic
MBR-025220CLM-411622
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009799
Orphan claim re-pointed
Claims processor
CLM-405441 → UHC-00989-26 (Diana Washington)
Member id
UHC-00989-26
Confidence
0.97
Method
deterministic
MBR-034371CLM-405441
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009800
Orphan claim re-pointed
Claims processor
CLM-410913 → UHC-70981-11 (Diana Chapman)
Member id
UHC-70981-11
Confidence
0.98
Method
probabilistic
MBR-021218CLM-410913
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009801
Orphan claim re-pointed
Claims processor
CLM-421924 → UHC-34912-88 (Theresa Henry)
Member id
UHC-34912-88
Confidence
0.86
Method
probabilistic
MBR-016456CLM-421924
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009802
Orphan claim re-pointed
Claims processor
CLM-428862 → UHC-46807-70 (Arthur Johnson)
Member id
UHC-46807-70
Confidence
0.97
Method
deterministic
MBR-000062CLM-428862
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009803
Orphan claim re-pointed
Claims processor
CLM-418385 → UHC-94457-68 (David Larson)
Member id
UHC-94457-68
Confidence
0.97
Method
deterministic
MBR-030109CLM-418385
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009804
Orphan claim re-pointed
Claims processor
CLM-412693 → UHC-07446-40 (Isabella Torres)
Member id
UHC-07446-40
Confidence
1
Method
probabilistic
MBR-017706CLM-412693
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009805
Orphan claim re-pointed
Claims processor
CLM-407374 → UHC-52585-76 (Santiago Elliott)
Member id
UHC-52585-76
Confidence
1
Method
probabilistic
MBR-025676CLM-407374
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009806
Orphan claim re-pointed
Claims processor
CLM-420981 → UHC-63371-59 (Andrew Fernandez)
Member id
UHC-63371-59
Confidence
1
Method
probabilistic
MBR-033159CLM-420981
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009807
Orphan claim re-pointed
Claims processor
CLM-421869 → UHC-92926-86 (Brenda Grant)
Member id
UHC-92926-86
Confidence
1
Method
probabilistic
MBR-004821CLM-421869
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009808
Orphan claim re-pointed
Claims processor
CLM-414997 → UHC-13776-69 (Anthony Wilson)
Member id
UHC-13776-69
Confidence
1
Method
probabilistic
MBR-043147CLM-414997
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009809
Orphan claim re-pointed
Claims processor
CLM-412333 → UHC-82124-06 (Keith McDonald)
Member id
UHC-82124-06
Confidence
1
Method
probabilistic
MBR-001232CLM-412333
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009810
Orphan claim re-pointed
Claims processor
CLM-424838 → UHC-05807-14 (James Tran)
Member id
UHC-05807-14
Confidence
1
Method
probabilistic
MBR-040370CLM-424838
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009811
Orphan claim re-pointed
Claims processor
CLM-406493 → UHC-97310-50 (Luis Reed)
Member id
UHC-97310-50
Confidence
1
Method
probabilistic
MBR-011107CLM-406493
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009812
Orphan claim re-pointed
Claims processor
CLM-405546 → UHC-96787-07 (Katherine Ramos)
Member id
UHC-96787-07
Confidence
1.00
Method
probabilistic
MBR-014260CLM-405546
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009813
Orphan claim re-pointed
Claims processor
CLM-410045 → UHC-92857-60 (Sean Sean)
Member id
UHC-92857-60
Confidence
0.99
Method
probabilistic
MBR-026455CLM-410045
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009814
Orphan claim re-pointed
Claims processor
CLM-422224 → UHC-83444-60 (Billy Morales)
Member id
UHC-83444-60
Confidence
0.97
Method
deterministic
MBR-013536CLM-422224
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009815
Orphan claim re-pointed
Claims processor
CLM-419833 → UHC-11708-31 (Albert Jacobs)
Member id
UHC-11708-31
Confidence
1
Method
probabilistic
MBR-000235CLM-419833
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009816
Orphan claim re-pointed
Claims processor
CLM-407983 → UHC-93859-39 (Sara Watson)
Member id
UHC-93859-39
Confidence
0.97
Method
deterministic
MBR-008589CLM-407983
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009817
Orphan claim re-pointed
Claims processor
CLM-400429 → UHC-60033-71 (Bradley Carroll)
Member id
UHC-60033-71
Confidence
1
Method
probabilistic
MBR-016939CLM-400429
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009818
Orphan claim re-pointed
Claims processor
CLM-400440 → UHC-48650-39 (Juan Castro)
Member id
UHC-48650-39
Confidence
0.98
Method
probabilistic
MBR-005801CLM-400440
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009819
Orphan claim re-pointed
Claims processor
CLM-426117 → UHC-81435-34 (Kathleen Bryant)
Member id
UHC-81435-34
Confidence
1
Method
probabilistic
MBR-037879CLM-426117
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009820
Orphan claim re-pointed
Claims processor
CLM-426386 → UHC-77668-48 (Linda Washington)
Member id
UHC-77668-48
Confidence
1
Method
probabilistic
MBR-026537CLM-426386
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009821
Orphan claim re-pointed
Claims processor
CLM-424755 → UHC-15768-95 (Christine Jensen)
Member id
UHC-15768-95
Confidence
1
Method
probabilistic
MBR-031772CLM-424755
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009822
Orphan claim re-pointed
Claims processor
CLM-424741 → UHC-10537-45 (Santiago Peterson)
Member id
UHC-10537-45
Confidence
1
Method
probabilistic
MBR-022962CLM-424741
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009823
Orphan claim re-pointed
Claims processor
CLM-417634 → UHC-93885-30 (Adam Ruiz)
Member id
UHC-93885-30
Confidence
1
Method
probabilistic
MBR-009057CLM-417634
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009824
Orphan claim re-pointed
Claims processor
CLM-426784 → UHC-75200-93 (Angela Ellis)
Member id
UHC-75200-93
Confidence
0.99
Method
probabilistic
MBR-007350CLM-426784
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009825
Orphan claim re-pointed
Claims processor
CLM-410323 → UHC-25496-41 (Tyler Perkins)
Member id
UHC-25496-41
Confidence
0.97
Method
deterministic
MBR-012672CLM-410323
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009826
Orphan claim re-pointed
Claims processor
CLM-425908 → UHC-17034-92 (Sarah Santos)
Member id
UHC-17034-92
Confidence
0.97
Method
deterministic
MBR-043007CLM-425908
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009827
Orphan claim re-pointed
Claims processor
CLM-409429 → UHC-43731-30 (Nancy Carr)
Member id
UHC-43731-30
Confidence
1
Method
probabilistic
MBR-011214CLM-409429
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009828
Orphan claim re-pointed
Claims processor
CLM-422410 → UHC-97279-29 (Joseph Carter)
Member id
UHC-97279-29
Confidence
1
Method
probabilistic
MBR-003844CLM-422410
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009829
Orphan claim re-pointed
Claims processor
CLM-407522 → UHC-46334-94 (Keith Nguyen)
Member id
UHC-46334-94
Confidence
1
Method
probabilistic
MBR-001045CLM-407522
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009830
Orphan claim re-pointed
Claims processor
CLM-404409 → UHC-78331-45 (Matthew White)
Member id
UHC-78331-45
Confidence
1
Method
probabilistic
MBR-001306CLM-404409
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009831
Orphan claim re-pointed
Claims processor
CLM-424514 → UHC-83159-99 (James Delgado)
Member id
UHC-83159-99
Confidence
1
Method
probabilistic
MBR-042384CLM-424514
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009832
Orphan claim re-pointed
Claims processor
CLM-407725 → UHC-99654-35 (Carlos Hamilton)
Member id
UHC-99654-35
Confidence
1
Method
probabilistic
MBR-010125CLM-407725
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009833
Orphan claim re-pointed
Claims processor
CLM-422291 → UHC-85073-69 (Logan Washington)
Member id
UHC-85073-69
Confidence
1
Method
probabilistic
MBR-041803CLM-422291
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009834
Orphan claim re-pointed
Claims processor
CLM-409785 → UHC-13667-19 (Mariana Stevens)
Member id
UHC-13667-19
Confidence
1
Method
probabilistic
MBR-005475CLM-409785
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009835
Orphan claim re-pointed
Claims processor
CLM-430967 → UHC-79600-13 (Frank Wright)
Member id
UHC-79600-13
Confidence
0.97
Method
deterministic
MBR-027640CLM-430967
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009836
Orphan claim re-pointed
Claims processor
CLM-422969 → UHC-80359-24 (Carol Pierce)
Member id
UHC-80359-24
Confidence
1
Method
probabilistic
MBR-011673CLM-422969
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009837
Orphan claim re-pointed
Claims processor
CLM-427417 → UHC-09454-42 (Karen Fowler)
Member id
UHC-09454-42
Confidence
1
Method
probabilistic
MBR-002592CLM-427417
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009838
Orphan claim re-pointed
Claims processor
CLM-431607 → UHC-47185-87 (Kelly Olson)
Member id
UHC-47185-87
Confidence
1
Method
probabilistic
MBR-005082CLM-431607
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009839
Orphan claim re-pointed
Claims processor
CLM-427766 → UHC-93261-88 (Anthony Harris)
Member id
UHC-93261-88
Confidence
1
Method
probabilistic
MBR-025039CLM-427766
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 170 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.