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-009890
Orphan claim re-pointed
Claims processor
CLM-426124 → UHC-41254-21 (Logan Lucas)
Member id
UHC-41254-21
Confidence
1
Method
probabilistic
MBR-025515CLM-426124
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009891
Orphan claim re-pointed
Claims processor
CLM-409246 → UHC-42045-03 (Pamela Simpson)
Member id
UHC-42045-03
Confidence
0.97
Method
deterministic
MBR-029041CLM-409246
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009892
Orphan claim re-pointed
Claims processor
CLM-431759 → UHC-17325-49 (Peter Green)
Member id
UHC-17325-49
Confidence
1
Method
probabilistic
MBR-003631CLM-431759
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009893
Orphan claim re-pointed
Claims processor
CLM-413139 → UHC-33926-12 (John Gomez)
Member id
UHC-33926-12
Confidence
0.97
Method
deterministic
MBR-010932CLM-413139
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009894
Orphan claim re-pointed
Claims processor
CLM-401379 → UHC-13802-06 (Carol Powell)
Member id
UHC-13802-06
Confidence
0.97
Method
deterministic
MBR-022371CLM-401379
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009895
Orphan claim re-pointed
Claims processor
CLM-401375 → UHC-37002-76 (Ahmed Lane)
Member id
UHC-37002-76
Confidence
1
Method
probabilistic
MBR-014791CLM-401375
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009896
Orphan claim re-pointed
Claims processor
CLM-415755 → UHC-34186-32 (Nicole Daniels)
Member id
UHC-34186-32
Confidence
1
Method
probabilistic
MBR-008228CLM-415755
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009897
Orphan claim re-pointed
Claims processor
CLM-403514 → UHC-24064-83 (Ronald Alvarado)
Member id
UHC-24064-83
Confidence
1
Method
probabilistic
MBR-010367CLM-403514
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009898
Orphan claim re-pointed
Claims processor
CLM-427242 → UHC-47675-96 (Stephen Carter)
Member id
UHC-47675-96
Confidence
1
Method
probabilistic
MBR-026324CLM-427242
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009899
Orphan claim re-pointed
Claims processor
CLM-423920 → UHC-17176-96 (Ralph Burke)
Member id
UHC-17176-96
Confidence
1
Method
probabilistic
MBR-037057CLM-423920
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009900
Orphan claim re-pointed
Claims processor
CLM-403475 → UHC-95401-16 (Kathryn Pierce)
Member id
UHC-95401-16
Confidence
0.99
Method
probabilistic
MBR-006669CLM-403475
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009901
Orphan claim re-pointed
Claims processor
CLM-400761 → UHC-98621-01 (Ruth Taylor)
Member id
UHC-98621-01
Confidence
1
Method
probabilistic
MBR-006206CLM-400761
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009902
Orphan claim re-pointed
Claims processor
CLM-415482 → UHC-09218-86 (Catherine Lawrence)
Member id
UHC-09218-86
Confidence
1
Method
probabilistic
MBR-013253CLM-415482
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009903
Orphan claim re-pointed
Claims processor
CLM-412223 → UHC-78896-26 (Priya Henry)
Member id
UHC-78896-26
Confidence
0.97
Method
deterministic
MBR-029030CLM-412223
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009904
Orphan claim re-pointed
Claims processor
CLM-425841 → UHC-82624-24 (Dorothy Wang)
Member id
UHC-82624-24
Confidence
1
Method
probabilistic
MBR-007912CLM-425841
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009905
Orphan claim re-pointed
Claims processor
CLM-424231 → UHC-82341-82 (Stephanie Porter)
Member id
UHC-82341-82
Confidence
1
Method
probabilistic
MBR-005935CLM-424231
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009906
Orphan claim re-pointed
Claims processor
CLM-424142 → UHC-49248-34 (Gabriel Wood)
Member id
UHC-49248-34
Confidence
1
Method
probabilistic
MBR-037202CLM-424142
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009907
Orphan claim re-pointed
Claims processor
CLM-428568 → UHC-59290-66 (Kimberly Harvey)
Member id
UHC-59290-66
Confidence
0.97
Method
deterministic
MBR-009522CLM-428568
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009908
Orphan claim re-pointed
Claims processor
CLM-425455 → UHC-53924-24 (Laura Obrien)
Member id
UHC-53924-24
Confidence
1
Method
probabilistic
MBR-002945CLM-425455
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009909
Orphan claim re-pointed
Claims processor
CLM-406191 → UHC-12037-69 (Gabriel Brown)
Member id
UHC-12037-69
Confidence
1
Method
probabilistic
MBR-011307CLM-406191
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009910
Orphan claim re-pointed
Claims processor
CLM-403773 → UHC-91293-76 (Bryan Guerrero)
Member id
UHC-91293-76
Confidence
1
Method
probabilistic
MBR-021623CLM-403773
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009911
Orphan claim re-pointed
Claims processor
CLM-411254 → UHC-14318-72 (Gabriel Gray)
Member id
UHC-14318-72
Confidence
0.97
Method
deterministic
MBR-016583CLM-411254
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009912
Orphan claim re-pointed
Claims processor
CLM-411956 → UHC-27814-80 (Henry Alvarez)
Member id
UHC-27814-80
Confidence
1
Method
probabilistic
MBR-031104CLM-411956
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009913
Orphan claim re-pointed
Claims processor
CLM-401168 → UHC-62794-28 (Maria Carroll)
Member id
UHC-62794-28
Confidence
1
Method
probabilistic
MBR-005563CLM-401168
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009914
Orphan claim re-pointed
Claims processor
CLM-425553 → UHC-52127-72 (Emily White)
Member id
UHC-52127-72
Confidence
1
Method
probabilistic
MBR-001035CLM-425553
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009915
Orphan claim re-pointed
Claims processor
CLM-427309 → UHC-55595-27 (Patricia Adams)
Member id
UHC-55595-27
Confidence
0.99
Method
probabilistic
MBR-013261CLM-427309
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009916
Orphan claim re-pointed
Claims processor
CLM-402563 → UHC-95810-35 (Karen Johnston)
Member id
UHC-95810-35
Confidence
1
Method
probabilistic
MBR-035952CLM-402563
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009917
Orphan claim re-pointed
Claims processor
CLM-417686 → UHC-45514-20 (Jack Lawson)
Member id
UHC-45514-20
Confidence
1
Method
probabilistic
MBR-038445CLM-417686
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009918
Orphan claim re-pointed
Claims processor
CLM-424046 → UHC-22131-74 (Henry Ross)
Member id
UHC-22131-74
Confidence
1
Method
probabilistic
MBR-037949CLM-424046
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009919
Orphan claim re-pointed
Claims processor
CLM-401717 → UHC-60493-89 (Camila James)
Member id
UHC-60493-89
Confidence
0.99
Method
probabilistic
MBR-005539CLM-401717
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009920
Orphan claim re-pointed
Claims processor
CLM-420754 → UHC-94810-45 (Ashley Walker)
Member id
UHC-94810-45
Confidence
1
Method
probabilistic
MBR-012508CLM-420754
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009921
Orphan claim re-pointed
Claims processor
CLM-400231 → UHC-55219-48 (Austin Stone)
Member id
UHC-55219-48
Confidence
0.97
Method
deterministic
MBR-019088CLM-400231
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009922
Orphan claim re-pointed
Claims processor
CLM-407536 → UHC-53993-88 (Jose Silva)
Member id
UHC-53993-88
Confidence
0.99
Method
probabilistic
MBR-036010CLM-407536
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009923
Orphan claim re-pointed
Claims processor
CLM-402798 → UHC-94418-36 (Jose Alvarez)
Member id
UHC-94418-36
Confidence
1
Method
probabilistic
MBR-019955CLM-402798
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009924
Orphan claim re-pointed
Claims processor
CLM-402158 → UHC-54463-75 (Richard Barnes)
Member id
UHC-54463-75
Confidence
0.93
Method
probabilistic
MBR-018787CLM-402158
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009925
Orphan claim re-pointed
Claims processor
CLM-411177 → UHC-84331-08 (Victoria Padilla)
Member id
UHC-84331-08
Confidence
1
Method
probabilistic
MBR-011844CLM-411177
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009926
Orphan claim re-pointed
Claims processor
CLM-411027 → UHC-45537-10 (Sara Andrews)
Member id
UHC-45537-10
Confidence
1
Method
probabilistic
MBR-034288CLM-411027
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009927
Orphan claim re-pointed
Claims processor
CLM-427668 → UHC-06238-41 (Josh Hudson)
Member id
UHC-06238-41
Confidence
0.99
Method
probabilistic
MBR-019744CLM-427668
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009928
Orphan claim re-pointed
Claims processor
CLM-426612 → UHC-55922-83 (Elizabeth Reed)
Member id
UHC-55922-83
Confidence
0.94
Method
probabilistic
MBR-033087CLM-426612
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009929
Orphan claim re-pointed
Claims processor
CLM-425470 → UHC-53604-06 (Steven Ramos)
Member id
UHC-53604-06
Confidence
1
Method
probabilistic
MBR-008981CLM-425470
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009930
Orphan claim re-pointed
Claims processor
CLM-416809 → UHC-94131-80 (Janet Cruz)
Member id
UHC-94131-80
Confidence
1
Method
probabilistic
MBR-004760CLM-416809
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009931
Orphan claim re-pointed
Claims processor
CLM-403265 → UHC-07851-61 (Keith Price)
Member id
UHC-07851-61
Confidence
1
Method
probabilistic
MBR-026831CLM-403265
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009932
Orphan claim re-pointed
Claims processor
CLM-412360 → UHC-80875-48 (Janice Hanson)
Member id
UHC-80875-48
Confidence
1
Method
probabilistic
MBR-011355CLM-412360
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009933
Orphan claim re-pointed
Claims processor
CLM-428051 → UHC-49331-36 (Ethan Williamson)
Member id
UHC-49331-36
Confidence
0.93
Method
probabilistic
MBR-021932CLM-428051
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009934
Orphan claim re-pointed
Claims processor
CLM-419218 → UHC-20139-14 (Alice Gordon)
Member id
UHC-20139-14
Confidence
1
Method
probabilistic
MBR-018449CLM-419218
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009935
Orphan claim re-pointed
Claims processor
CLM-422157 → UHC-48315-62 (James Reid)
Member id
UHC-48315-62
Confidence
1
Method
probabilistic
MBR-010522CLM-422157
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009936
Orphan claim re-pointed
Claims processor
CLM-406669 → UHC-02515-86 (Jean Brown)
Member id
UHC-02515-86
Confidence
0.99
Method
probabilistic
MBR-014873CLM-406669
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009937
Orphan claim re-pointed
Claims processor
CLM-428890 → UHC-82069-96 (Helen Woods)
Member id
UHC-82069-96
Confidence
1
Method
probabilistic
MBR-019441CLM-428890
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009938
Orphan claim re-pointed
Claims processor
CLM-431394 → UHC-93292-52 (Diana Williamson)
Member id
UHC-93292-52
Confidence
1
Method
probabilistic
MBR-023689CLM-431394
Executed
resolution_agent
2026-10-22 12:47:23
ACT-009939
Orphan claim re-pointed
Claims processor
CLM-431998 → UHC-24782-47 (Ralph Mejia)
Member id
UHC-24782-47
Confidence
1
Method
probabilistic
MBR-027172CLM-431998
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 172 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.