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-002240
Orphan claim re-pointed
Claims processor
CLM-430396 → UHC-43705-52 (Margaret Jordan)
Member id
UHC-43705-52
Confidence
0.97
Method
deterministic
MBR-017087CLM-430396
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002241
Orphan claim re-pointed
Claims processor
CLM-411937 → UHC-39559-25 (Keith Ramirez)
Member id
UHC-39559-25
Confidence
0.97
Method
deterministic
MBR-026354CLM-411937
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002242
Orphan claim re-pointed
Claims processor
CLM-425751 → UHC-12395-95 (Nicole Grant)
Member id
UHC-12395-95
Confidence
0.99
Method
probabilistic
MBR-009772CLM-425751
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002243
Orphan claim re-pointed
Claims processor
CLM-408224 → UHC-56619-38 (Sarah Spencer)
Member id
UHC-56619-38
Confidence
0.97
Method
deterministic
MBR-016109CLM-408224
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002244
Orphan claim re-pointed
Claims processor
CLM-410429 → UHC-36655-13 (Anna Dunn)
Member id
UHC-36655-13
Confidence
1
Method
probabilistic
MBR-015284CLM-410429
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002245
Orphan claim re-pointed
Claims processor
CLM-428446 → UHC-66752-04 (Michael Holmes)
Member id
UHC-66752-04
Confidence
1
Method
probabilistic
MBR-004101CLM-428446
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002246
Orphan claim re-pointed
Claims processor
CLM-414399 → UHC-11000-88 (Julie Ellis)
Member id
UHC-11000-88
Confidence
0.86
Method
probabilistic
MBR-009357CLM-414399
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002247
Orphan claim re-pointed
Claims processor
CLM-427509 → UHC-79109-70 (Arthur Ray)
Member id
UHC-79109-70
Confidence
1
Method
probabilistic
MBR-002469CLM-427509
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002248
Orphan claim re-pointed
Claims processor
CLM-413830 → UHC-49708-56 (Karen Gibson)
Member id
UHC-49708-56
Confidence
1
Method
probabilistic
MBR-022056CLM-413830
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002249
Orphan claim re-pointed
Claims processor
CLM-414520 → UHC-46817-61 (Mateo Perez)
Member id
UHC-46817-61
Confidence
1
Method
probabilistic
MBR-017686CLM-414520
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002250
Orphan claim re-pointed
Claims processor
CLM-426755 → UHC-35632-44 (Walter Benntt)
Member id
UHC-35632-44
Confidence
0.99
Method
probabilistic
MBR-002616CLM-426755
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002251
Orphan claim re-pointed
Claims processor
CLM-416657 → UHC-21051-13 (Judith Simpson)
Member id
UHC-21051-13
Confidence
1
Method
probabilistic
MBR-024063CLM-416657
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002252
Orphan claim re-pointed
Claims processor
CLM-402908 → UHC-56867-96 (Peter Brooks)
Member id
UHC-56867-96
Confidence
1
Method
probabilistic
MBR-023790CLM-402908
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002253
Orphan claim re-pointed
Claims processor
CLM-416512 → UHC-92965-58 (Anthony Cox)
Member id
UHC-92965-58
Confidence
1
Method
probabilistic
MBR-025583CLM-416512
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002254
Orphan claim re-pointed
Claims processor
CLM-418287 → UHC-71635-91 (Natalie Stewart)
Member id
UHC-71635-91
Confidence
1
Method
probabilistic
MBR-022420CLM-418287
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002255
Orphan claim re-pointed
Claims processor
CLM-410415 → UHC-25697-06 (Theresa Foster)
Member id
UHC-25697-06
Confidence
1
Method
probabilistic
MBR-030766CLM-410415
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002256
Orphan claim re-pointed
Claims processor
CLM-420347 → UHC-55251-71 (Mateo Vega)
Member id
UHC-55251-71
Confidence
1
Method
probabilistic
MBR-003916CLM-420347
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002257
Orphan claim re-pointed
Claims processor
CLM-428177 → UHC-35334-30 (Jerry Mendez)
Member id
UHC-35334-30
Confidence
1
Method
probabilistic
MBR-001453CLM-428177
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002258
Orphan claim re-pointed
Claims processor
CLM-403555 → UHC-08946-09 (Marilyn Elliott)
Member id
UHC-08946-09
Confidence
1
Method
probabilistic
MBR-012029CLM-403555
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002259
Orphan claim re-pointed
Claims processor
CLM-422518 → UHC-10447-33 (Alice Bishop)
Member id
UHC-10447-33
Confidence
1
Method
probabilistic
MBR-036963CLM-422518
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002260
Orphan claim re-pointed
Claims processor
CLM-429270 → UHC-12979-32 (Amanda Day)
Member id
UHC-12979-32
Confidence
0.97
Method
deterministic
MBR-000047CLM-429270
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002261
Orphan claim re-pointed
Claims processor
CLM-407768 → UHC-21146-15 (Glria Black)
Member id
UHC-21146-15
Confidence
1.00
Method
probabilistic
MBR-008689CLM-407768
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002262
Orphan claim re-pointed
Claims processor
CLM-413797 → UHC-86977-16 (Matthew Hall)
Member id
UHC-86977-16
Confidence
0.97
Method
deterministic
MBR-034926CLM-413797
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002263
Orphan claim re-pointed
Claims processor
CLM-426875 → UHC-95535-50 (Henry Watson)
Member id
UHC-95535-50
Confidence
1
Method
probabilistic
MBR-006448CLM-426875
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002264
Orphan claim re-pointed
Claims processor
CLM-430656 → UHC-52639-52 (Valentina White)
Member id
UHC-52639-52
Confidence
1
Method
probabilistic
MBR-029275CLM-430656
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002265
Orphan claim re-pointed
Claims processor
CLM-403429 → UHC-86878-50 (Aisha Cole)
Member id
UHC-86878-50
Confidence
1
Method
probabilistic
MBR-030273CLM-403429
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002266
Orphan claim re-pointed
Claims processor
CLM-409998 → UHC-20829-55 (Pamela Hicks)
Member id
UHC-20829-55
Confidence
1
Method
probabilistic
MBR-041930CLM-409998
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002267
Orphan claim re-pointed
Claims processor
CLM-410582 → UHC-72826-07 (Walter Griffin)
Member id
UHC-72826-07
Confidence
1
Method
probabilistic
MBR-012919CLM-410582
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002268
Orphan claim re-pointed
Claims processor
CLM-406289 → UHC-75403-09 (Judy Alexander)
Member id
UHC-75403-09
Confidence
0.97
Method
deterministic
MBR-021600CLM-406289
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002269
Orphan claim re-pointed
Claims processor
CLM-406745 → UHC-77558-15 (Patricia Mendez)
Member id
UHC-77558-15
Confidence
1
Method
probabilistic
MBR-010556CLM-406745
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002270
Orphan claim re-pointed
Claims processor
CLM-428133 → UHC-27972-26 (Jack Wheeler)
Member id
UHC-27972-26
Confidence
0.97
Method
deterministic
MBR-017787CLM-428133
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002271
Orphan claim re-pointed
Claims processor
CLM-415304 → UHC-73297-66 (Amy Lawrence)
Member id
UHC-73297-66
Confidence
1
Method
probabilistic
MBR-004287CLM-415304
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002272
Orphan claim re-pointed
Claims processor
CLM-408446 → UHC-42065-41 (Alice Howard)
Member id
UHC-42065-41
Confidence
1
Method
probabilistic
MBR-034972CLM-408446
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002273
Orphan claim re-pointed
Claims processor
CLM-414979 → UHC-18151-08 (Diego Fox)
Member id
UHC-18151-08
Confidence
0.97
Method
deterministic
MBR-015234CLM-414979
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002274
Orphan claim re-pointed
Claims processor
CLM-428851 → UHC-62466-60 (Nancy Soto)
Member id
UHC-62466-60
Confidence
1
Method
probabilistic
MBR-025342CLM-428851
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002275
Orphan claim re-pointed
Claims processor
CLM-421316 → UHC-24208-80 (Abigail Soto)
Member id
UHC-24208-80
Confidence
0.97
Method
deterministic
MBR-016367CLM-421316
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002276
Orphan claim re-pointed
Claims processor
CLM-401522 → UHC-28393-22 (Denise Petesr)
Member id
UHC-28393-22
Confidence
1
Method
probabilistic
MBR-025374CLM-401522
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002277
Orphan claim re-pointed
Claims processor
CLM-419781 → UHC-40579-79 (Chris Meyer)
Member id
UHC-40579-79
Confidence
1
Method
probabilistic
MBR-002421CLM-419781
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002278
Orphan claim re-pointed
Claims processor
CLM-420871 → UHC-07640-06 (Donna Cook)
Member id
UHC-07640-06
Confidence
0.97
Method
deterministic
MBR-027943CLM-420871
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002279
Orphan claim re-pointed
Claims processor
CLM-423039 → UHC-28932-50 (Christina Andrews)
Member id
UHC-28932-50
Confidence
0.97
Method
deterministic
MBR-034822CLM-423039
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002280
Orphan claim re-pointed
Claims processor
CLM-408621 → UHC-33957-43 (Kyle Vega)
Member id
UHC-33957-43
Confidence
1
Method
probabilistic
MBR-011634CLM-408621
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002281
Orphan claim re-pointed
Claims processor
CLM-401178 → UHC-29262-82 (Mark Gomez)
Member id
UHC-29262-82
Confidence
1
Method
probabilistic
MBR-043828CLM-401178
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002282
Orphan claim re-pointed
Claims processor
CLM-401214 → UHC-22994-76 (Carl Morrison)
Member id
UHC-22994-76
Confidence
1
Method
probabilistic
MBR-003029CLM-401214
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002283
Orphan claim re-pointed
Claims processor
CLM-427858 → UHC-70759-17 (Bradley Hernandez)
Member id
UHC-70759-17
Confidence
1
Method
probabilistic
MBR-021886CLM-427858
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002284
Orphan claim re-pointed
Claims processor
CLM-406596 → UHC-02077-12 (Hiroshi Lewis)
Member id
UHC-02077-12
Confidence
0.93
Method
probabilistic
MBR-008672CLM-406596
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002285
Orphan claim re-pointed
Claims processor
CLM-422439 → UHC-22819-36 (Emma Silva)
Member id
UHC-22819-36
Confidence
1
Method
probabilistic
MBR-000644CLM-422439
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002286
Orphan claim re-pointed
Claims processor
CLM-401421 → UHC-10593-35 (Heather Le)
Member id
UHC-10593-35
Confidence
0.97
Method
deterministic
MBR-014812CLM-401421
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002287
Orphan claim re-pointed
Claims processor
CLM-407141 → UHC-38908-32 (Mateo Kelly)
Member id
UHC-38908-32
Confidence
0.97
Method
deterministic
MBR-025597CLM-407141
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002288
Orphan claim re-pointed
Claims processor
CLM-421177 → UHC-73240-85 (Willie Le)
Member id
UHC-73240-85
Confidence
0.98
Method
probabilistic
MBR-000447CLM-421177
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002289
Orphan claim re-pointed
Claims processor
CLM-420877 → UHC-22366-98 (Kenneth Gonzales)
Member id
UHC-22366-98
Confidence
1
Method
probabilistic
MBR-025649CLM-420877
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 19 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.