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-010240
Orphan claim re-pointed
Claims processor
CLM-428474 → UHC-57938-52 (Harold Sanders)
Member id
UHC-57938-52
Confidence
0.97
Method
deterministic
MBR-032807CLM-428474
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010241
Orphan claim re-pointed
Claims processor
CLM-431667 → UHC-82668-02 (Joe Chen)
Member id
UHC-82668-02
Confidence
0.97
Method
deterministic
MBR-010752CLM-431667
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010242
Orphan claim re-pointed
Claims processor
CLM-429247 → UHC-97041-61 (Carlos Bailey)
Member id
UHC-97041-61
Confidence
1
Method
probabilistic
MBR-013334CLM-429247
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010243
Orphan claim re-pointed
Claims processor
CLM-425689 → UHC-67983-70 (Gloria Gilbert)
Member id
UHC-67983-70
Confidence
1
Method
probabilistic
MBR-019087CLM-425689
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010244
Orphan claim re-pointed
Claims processor
CLM-409130 → UHC-80002-66 (Ralph Ryan)
Member id
UHC-80002-66
Confidence
0.99
Method
probabilistic
MBR-010256CLM-409130
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010245
Orphan claim re-pointed
Claims processor
CLM-419979 → UHC-19875-43 (Jeremy Roberts)
Member id
UHC-19875-43
Confidence
1
Method
probabilistic
MBR-016960CLM-419979
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010246
Orphan claim re-pointed
Claims processor
CLM-415246 → UHC-89426-04 (Jeremy Vegga)
Member id
UHC-89426-04
Confidence
0.97
Method
probabilistic
MBR-012839CLM-415246
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010247
Orphan claim re-pointed
Claims processor
CLM-400487 → UHC-91671-60 (Evelyn Nguyen)
Member id
UHC-91671-60
Confidence
0.97
Method
deterministic
MBR-019061CLM-400487
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010248
Orphan claim re-pointed
Claims processor
CLM-432157 → UHC-63996-85 (Michael Weber)
Member id
UHC-63996-85
Confidence
0.97
Method
deterministic
MBR-038266CLM-432157
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010249
Orphan claim re-pointed
Claims processor
CLM-401555 → UHC-41097-25 (Edward Bakker)
Member id
UHC-41097-25
Confidence
0.99
Method
probabilistic
MBR-021997CLM-401555
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010250
Orphan claim re-pointed
Claims processor
CLM-408236 → UHC-98552-44 (Sandra Anderson)
Member id
UHC-98552-44
Confidence
1
Method
probabilistic
MBR-004098CLM-408236
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010251
Orphan claim re-pointed
Claims processor
CLM-427061 → UHC-34285-94 (Amanda Singh)
Member id
UHC-34285-94
Confidence
0.99
Method
probabilistic
MBR-013105CLM-427061
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010252
Orphan claim re-pointed
Claims processor
CLM-427421 → UHC-95747-72 (Grace Watkins)
Member id
UHC-95747-72
Confidence
1
Method
probabilistic
MBR-031284CLM-427421
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010253
Orphan claim re-pointed
Claims processor
CLM-416170 → UHC-38127-44 (Patrick Schmidt)
Member id
UHC-38127-44
Confidence
1
Method
probabilistic
MBR-014777CLM-416170
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010254
Orphan claim re-pointed
Claims processor
CLM-409213 → UHC-35022-20 (Nicholas Patterson)
Member id
UHC-35022-20
Confidence
1
Method
probabilistic
MBR-004572CLM-409213
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010255
Orphan claim re-pointed
Claims processor
CLM-429878 → UHC-49630-51 (Kaith Rogers)
Member id
UHC-49630-51
Confidence
0.97
Method
deterministic
MBR-024149CLM-429878
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010256
Orphan claim re-pointed
Claims processor
CLM-419224 → UHC-55225-29 (Ann Kennedy)
Member id
UHC-55225-29
Confidence
1
Method
probabilistic
MBR-005104CLM-419224
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010257
Orphan claim re-pointed
Claims processor
CLM-421929 → UHC-08853-29 (Nancy Howard)
Member id
UHC-08853-29
Confidence
1
Method
probabilistic
MBR-009466CLM-421929
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010258
Orphan claim re-pointed
Claims processor
CLM-415324 → UHC-14555-90 (Margaret Burke)
Member id
UHC-14555-90
Confidence
1
Method
probabilistic
MBR-000335CLM-415324
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010259
Orphan claim re-pointed
Claims processor
CLM-431737 → UHC-18114-77 (Arthur Valdez)
Member id
UHC-18114-77
Confidence
1
Method
probabilistic
MBR-022227CLM-431737
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010260
Orphan claim re-pointed
Claims processor
CLM-414437 → UHC-27182-89 (Wei Washington)
Member id
UHC-27182-89
Confidence
1
Method
probabilistic
MBR-012530CLM-414437
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010261
Orphan claim re-pointed
Claims processor
CLM-421788 → UHC-34084-45 (James Rice)
Member id
UHC-34084-45
Confidence
1
Method
probabilistic
MBR-013940CLM-421788
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010262
Orphan claim re-pointed
Claims processor
CLM-418619 → UHC-24776-39 (Mariana Matthews)
Member id
UHC-24776-39
Confidence
0.97
Method
deterministic
MBR-044168CLM-418619
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010263
Orphan claim re-pointed
Claims processor
CLM-418390 → UHC-43878-46 (Mary Fuller)
Member id
UHC-43878-46
Confidence
1
Method
probabilistic
MBR-014038CLM-418390
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010264
Orphan claim re-pointed
Claims processor
CLM-412629 → UHC-94994-63 (Jordan Ferguson)
Member id
UHC-94994-63
Confidence
0.97
Method
deterministic
MBR-046006CLM-412629
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010265
Orphan claim re-pointed
Claims processor
CLM-408245 → UHC-24383-41 (Valentina Harris)
Member id
UHC-24383-41
Confidence
0.97
Method
deterministic
MBR-000825CLM-408245
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010266
Orphan claim re-pointed
Claims processor
CLM-410370 → UHC-25525-72 (Aaron Larson)
Member id
UHC-25525-72
Confidence
1
Method
probabilistic
MBR-014413CLM-410370
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010267
Orphan claim re-pointed
Claims processor
CLM-405711 → UHC-29830-20 (Luis Richardson)
Member id
UHC-29830-20
Confidence
0.97
Method
deterministic
MBR-027348CLM-405711
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010268
Orphan claim re-pointed
Claims processor
CLM-410180 → UHC-44034-72 (Dylan Simpson)
Member id
UHC-44034-72
Confidence
0.99
Method
probabilistic
MBR-004237CLM-410180
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010269
Orphan claim re-pointed
Claims processor
CLM-415836 → UHC-77559-84 (Randy Robertson)
Member id
UHC-77559-84
Confidence
0.93
Method
probabilistic
MBR-006582CLM-415836
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010270
Orphan claim re-pointed
Claims processor
CLM-414100 → UHC-91321-72 (Amanda Shaw)
Member id
UHC-91321-72
Confidence
1
Method
probabilistic
MBR-000905CLM-414100
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010271
Orphan claim re-pointed
Claims processor
CLM-405582 → UHC-73047-84 (Megan Nunez)
Member id
UHC-73047-84
Confidence
0.97
Method
deterministic
MBR-029339CLM-405582
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010272
Orphan claim re-pointed
Claims processor
CLM-401620 → UHC-58756-45 (Diana Rice)
Member id
UHC-58756-45
Confidence
0.97
Method
deterministic
MBR-030859CLM-401620
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010273
Orphan claim re-pointed
Claims processor
CLM-427346 → UHC-40250-67 (Scott Boyd)
Member id
UHC-40250-67
Confidence
1
Method
probabilistic
MBR-009180CLM-427346
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010274
Orphan claim re-pointed
Claims processor
CLM-414006 → UHC-58745-51 (Mariana Dixon)
Member id
UHC-58745-51
Confidence
1
Method
probabilistic
MBR-000270CLM-414006
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010275
Orphan claim re-pointed
Claims processor
CLM-422433 → UHC-09620-25 (Elijah Harper)
Member id
UHC-09620-25
Confidence
1
Method
probabilistic
MBR-007433CLM-422433
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010276
Orphan claim re-pointed
Claims processor
CLM-429371 → UHC-91805-80 (Logan Sanders)
Member id
UHC-91805-80
Confidence
0.88
Method
probabilistic
MBR-006796CLM-429371
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010277
Orphan claim re-pointed
Claims processor
CLM-415536 → UHC-86006-63 (Charles Kelly)
Member id
UHC-86006-63
Confidence
0.97
Method
deterministic
MBR-009297CLM-415536
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010278
Orphan claim re-pointed
Claims processor
CLM-416831 → UHC-03653-51 (Priya Reynolds)
Member id
UHC-03653-51
Confidence
1
Method
probabilistic
MBR-024501CLM-416831
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010279
Orphan claim re-pointed
Claims processor
CLM-421099 → UHC-59343-89 (Ryan Li)
Member id
UHC-59343-89
Confidence
1
Method
probabilistic
MBR-022944CLM-421099
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010280
Orphan claim re-pointed
Claims processor
CLM-427429 → UHC-50725-95 (Mariana Rios)
Member id
UHC-50725-95
Confidence
1
Method
probabilistic
MBR-012642CLM-427429
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010281
Orphan claim re-pointed
Claims processor
CLM-423761 → UHC-79988-26 (Andrea Whhite)
Member id
UHC-79988-26
Confidence
0.99
Method
probabilistic
MBR-036394CLM-423761
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010282
Orphan claim re-pointed
Claims processor
CLM-431504 → UHC-12386-49 (Martha Harvey)
Member id
UHC-12386-49
Confidence
1
Method
probabilistic
MBR-004236CLM-431504
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010283
Orphan claim re-pointed
Claims processor
CLM-415279 → UHC-45484-87 (Omar Nichols)
Member id
UHC-45484-87
Confidence
1
Method
probabilistic
MBR-040446CLM-415279
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010284
Orphan claim re-pointed
Claims processor
CLM-407703 → UHC-94046-18 (Natalie Singh)
Member id
UHC-94046-18
Confidence
0.93
Method
probabilistic
MBR-041137CLM-407703
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010285
Orphan claim re-pointed
Claims processor
CLM-413737 → UHC-77267-25 (Jonathan Marquez)
Member id
UHC-77267-25
Confidence
0.94
Method
probabilistic
MBR-002176CLM-413737
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010286
Orphan claim re-pointed
Claims processor
CLM-428456 → UHC-75478-15 (Judith Castillo)
Member id
UHC-75478-15
Confidence
1
Method
probabilistic
MBR-012296CLM-428456
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010287
Orphan claim re-pointed
Claims processor
CLM-405410 → UHC-63626-44 (Diego Bradley)
Member id
UHC-63626-44
Confidence
1
Method
probabilistic
MBR-017284CLM-405410
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010288
Orphan claim re-pointed
Claims processor
CLM-418891 → UHC-47480-60 (Emily Young)
Member id
UHC-47480-60
Confidence
1
Method
probabilistic
MBR-014774CLM-418891
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010289
Orphan claim re-pointed
Claims processor
CLM-407961 → UHC-57784-50 (Keith Gordon)
Member id
UHC-57784-50
Confidence
0.97
Method
deterministic
MBR-037703CLM-407961
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 179 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.