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-010290
Orphan claim re-pointed
Claims processor
CLM-401694 → UHC-89176-51 (Victoria Phillips)
Member id
UHC-89176-51
Confidence
1
Method
probabilistic
MBR-017479CLM-401694
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010291
Orphan claim re-pointed
Claims processor
CLM-424209 → UHC-93669-60 (Anthony Harper)
Member id
UHC-93669-60
Confidence
0.97
Method
deterministic
MBR-028427CLM-424209
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010292
Orphan claim re-pointed
Claims processor
CLM-416101 → UHC-38069-86 (Yuki Marquez)
Member id
UHC-38069-86
Confidence
0.97
Method
deterministic
MBR-025568CLM-416101
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010293
Orphan claim re-pointed
Claims processor
CLM-410570 → UHC-43471-66 (Marilyn Patterson)
Member id
UHC-43471-66
Confidence
1
Method
probabilistic
MBR-002446CLM-410570
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010294
Orphan claim re-pointed
Claims processor
CLM-403110 → UHC-87746-30 (Andrea Fuller)
Member id
UHC-87746-30
Confidence
0.99
Method
probabilistic
MBR-020434CLM-403110
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010295
Orphan claim re-pointed
Claims processor
CLM-419259 → UHC-44427-94 (Stephen Grant)
Member id
UHC-44427-94
Confidence
1
Method
probabilistic
MBR-020418CLM-419259
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010296
Orphan claim re-pointed
Claims processor
CLM-412410 → UHC-95381-17 (Mei Nguyen)
Member id
UHC-95381-17
Confidence
1
Method
probabilistic
MBR-026811CLM-412410
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010297
Orphan claim re-pointed
Claims processor
CLM-415423 → UHC-81737-68 (Brittany Long)
Member id
UHC-81737-68
Confidence
1
Method
probabilistic
MBR-008540CLM-415423
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010298
Orphan claim re-pointed
Claims processor
CLM-427277 → UHC-45508-52 (Maria Stewart)
Member id
UHC-45508-52
Confidence
1
Method
probabilistic
MBR-022261CLM-427277
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010299
Orphan claim re-pointed
Claims processor
CLM-406543 → UHC-69641-21 (Maria Sandoval)
Member id
UHC-69641-21
Confidence
1
Method
probabilistic
MBR-010910CLM-406543
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010300
Orphan claim re-pointed
Claims processor
CLM-431949 → UHC-50163-50 (Kimberly Ferguson)
Member id
UHC-50163-50
Confidence
1
Method
probabilistic
MBR-005317CLM-431949
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010301
Orphan claim re-pointed
Claims processor
CLM-410280 → UHC-87261-18 (Angela Foster)
Member id
UHC-87261-18
Confidence
1
Method
probabilistic
MBR-003791CLM-410280
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010302
Orphan claim re-pointed
Claims processor
CLM-421070 → UHC-55115-85 (Paul Kelley)
Member id
UHC-55115-85
Confidence
1
Method
probabilistic
MBR-016747CLM-421070
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010303
Orphan claim re-pointed
Claims processor
CLM-415641 → UHC-85530-87 (Ronald Fuller)
Member id
UHC-85530-87
Confidence
1
Method
probabilistic
MBR-008627CLM-415641
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010304
Orphan claim re-pointed
Claims processor
CLM-403338 → UHC-80513-60 (Liz Robinson)
Member id
UHC-80513-60
Confidence
1
Method
probabilistic
MBR-035134CLM-403338
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010305
Orphan claim re-pointed
Claims processor
CLM-421467 → UHC-09837-69 (Karen Foster)
Member id
UHC-09837-69
Confidence
0.99
Method
probabilistic
MBR-000741CLM-421467
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010306
Orphan claim re-pointed
Claims processor
CLM-405114 → UHC-40896-79 (Nathan Soto)
Member id
UHC-40896-79
Confidence
1
Method
probabilistic
MBR-012101CLM-405114
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010307
Orphan claim re-pointed
Claims processor
CLM-412544 → UHC-99536-64 (Shirley Ryan)
Member id
UHC-99536-64
Confidence
1
Method
probabilistic
MBR-006171CLM-412544
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010308
Orphan claim re-pointed
Claims processor
CLM-422419 → UHC-28282-07 (Christian Little)
Member id
UHC-28282-07
Confidence
1.00
Method
probabilistic
MBR-016071CLM-422419
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010309
Orphan claim re-pointed
Claims processor
CLM-423759 → UHC-61634-34 (Judith Oliver)
Member id
UHC-61634-34
Confidence
1
Method
probabilistic
MBR-020167CLM-423759
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010310
Orphan claim re-pointed
Claims processor
CLM-432093 → UHC-20902-13 (Samantha Fuller)
Member id
UHC-20902-13
Confidence
1
Method
probabilistic
MBR-011008CLM-432093
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010311
Orphan claim re-pointed
Claims processor
CLM-421474 → UHC-26709-23 (Lauren Contreras)
Member id
UHC-26709-23
Confidence
1
Method
probabilistic
MBR-020423CLM-421474
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010312
Orphan claim re-pointed
Claims processor
CLM-411603 → UHC-23200-97 (Valentina Ortiz)
Member id
UHC-23200-97
Confidence
0.99
Method
probabilistic
MBR-013655CLM-411603
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010313
Orphan claim re-pointed
Claims processor
CLM-408324 → UHC-94064-39 (Larry Jones)
Member id
UHC-94064-39
Confidence
1
Method
probabilistic
MBR-003991CLM-408324
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010314
Orphan claim re-pointed
Claims processor
CLM-431030 → UHC-02650-81 (Edward Coleman)
Member id
UHC-02650-81
Confidence
1
Method
probabilistic
MBR-004872CLM-431030
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010315
Orphan claim re-pointed
Claims processor
CLM-428082 → UHC-19739-29 (Ethan Borwn)
Member id
UHC-19739-29
Confidence
0.97
Method
deterministic
MBR-020785CLM-428082
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010316
Orphan claim re-pointed
Claims processor
CLM-402031 → UHC-20989-04 (Robert Chen)
Member id
UHC-20989-04
Confidence
0.97
Method
deterministic
MBR-003658CLM-402031
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010317
Orphan claim re-pointed
Claims processor
CLM-421220 → UHC-70952-25 (Austin Franklin)
Member id
UHC-70952-25
Confidence
1
Method
probabilistic
MBR-010017CLM-421220
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010318
Orphan claim re-pointed
Claims processor
CLM-431295 → UHC-07094-27 (Ryan Burns)
Member id
UHC-07094-27
Confidence
0.97
Method
deterministic
MBR-008667CLM-431295
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010319
Orphan claim re-pointed
Claims processor
CLM-427048 → UHC-52608-79 (Beverly Andrews)
Member id
UHC-52608-79
Confidence
1
Method
probabilistic
MBR-013374CLM-427048
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010320
Orphan claim re-pointed
Claims processor
CLM-424823 → UHC-61196-41 (Ethan Welch)
Member id
UHC-61196-41
Confidence
0.97
Method
deterministic
MBR-017947CLM-424823
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010321
Orphan claim re-pointed
Claims processor
CLM-424958 → UHC-13803-78 (Victoria Herrera)
Member id
UHC-13803-78
Confidence
1
Method
probabilistic
MBR-017068CLM-424958
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010322
Orphan claim re-pointed
Claims processor
CLM-408222 → UHC-56619-38 (Sarah Spencer)
Member id
UHC-56619-38
Confidence
0.97
Method
deterministic
MBR-016109CLM-408222
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010323
Orphan claim re-pointed
Claims processor
CLM-428566 → UHC-24609-37 (Jacqueine Young)
Member id
UHC-24609-37
Confidence
1
Method
probabilistic
MBR-014054CLM-428566
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010324
Orphan claim re-pointed
Claims processor
CLM-404242 → UHC-86120-37 (Martha Romero)
Member id
UHC-86120-37
Confidence
1
Method
probabilistic
MBR-026232CLM-404242
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010325
Orphan claim re-pointed
Claims processor
CLM-432631 → UHC-06260-45 (Mateo Black)
Member id
UHC-06260-45
Confidence
1
Method
probabilistic
MBR-000774CLM-432631
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010326
Orphan claim re-pointed
Claims processor
CLM-407783 → UHC-93997-42 (Mark Harper)
Member id
UHC-93997-42
Confidence
1
Method
probabilistic
MBR-012829CLM-407783
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010327
Orphan claim re-pointed
Claims processor
CLM-421856 → UHC-81929-18 (Natalie Taylor)
Member id
UHC-81929-18
Confidence
1
Method
probabilistic
MBR-003527CLM-421856
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010328
Orphan claim re-pointed
Claims processor
CLM-427454 → UHC-42310-30 (Sean Day)
Member id
UHC-42310-30
Confidence
0.97
Method
deterministic
MBR-000197CLM-427454
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010329
Orphan claim re-pointed
Claims processor
CLM-430167 → UHC-99334-33 (Willie Chavez)
Member id
UHC-99334-33
Confidence
1
Method
probabilistic
MBR-028228CLM-430167
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010330
Orphan claim re-pointed
Claims processor
CLM-408220 → UHC-96093-29 (Katherine Lucas)
Member id
UHC-96093-29
Confidence
1
Method
probabilistic
MBR-014410CLM-408220
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010331
Orphan claim re-pointed
Claims processor
CLM-406366 → UHC-95750-97 (Jose Fuller)
Member id
UHC-95750-97
Confidence
0.97
Method
deterministic
MBR-006850CLM-406366
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010332
Orphan claim re-pointed
Claims processor
CLM-420235 → UHC-25421-25 (Karen Ruiz)
Member id
UHC-25421-25
Confidence
1
Method
probabilistic
MBR-005611CLM-420235
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010333
Orphan claim re-pointed
Claims processor
CLM-427182 → UHC-78868-43 (Jacob Patterson)
Member id
UHC-78868-43
Confidence
1
Method
probabilistic
MBR-011261CLM-427182
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010334
Orphan claim re-pointed
Claims processor
CLM-401658 → UHC-67995-68 (Fatima Taylor)
Member id
UHC-67995-68
Confidence
0.97
Method
deterministic
MBR-013422CLM-401658
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010335
Orphan claim re-pointed
Claims processor
CLM-424872 → UHC-21910-53 (Alice Porter)
Member id
UHC-21910-53
Confidence
1
Method
probabilistic
MBR-008822CLM-424872
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010336
Orphan claim re-pointed
Claims processor
CLM-416150 → UHC-55205-58 (Rebecca King)
Member id
UHC-55205-58
Confidence
0.93
Method
probabilistic
MBR-002942CLM-416150
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010337
Orphan claim re-pointed
Claims processor
CLM-432679 → UHC-43283-39 (Thomas Harper)
Member id
UHC-43283-39
Confidence
1
Method
probabilistic
MBR-014189CLM-432679
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010338
Orphan claim re-pointed
Claims processor
CLM-405752 → UHC-47381-71 (Janet Tran)
Member id
UHC-47381-71
Confidence
1
Method
probabilistic
MBR-013528CLM-405752
Executed
resolution_agent
2026-10-22 12:47:23
ACT-010339
Orphan claim re-pointed
Claims processor
CLM-401964 → UHC-42297-53 (Jordan McCoy)
Member id
UHC-42297-53
Confidence
1
Method
probabilistic
MBR-011163CLM-401964
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 180 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.