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-004012
Orphan claim re-pointed
Claims processor
CLM-413701 → UHC-94110-47 (Vincent Ruiz)
Member id
UHC-94110-47
Confidence
1
Method
probabilistic
MBR-019601CLM-413701
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004013
Orphan claim re-pointed
Claims processor
CLM-425529 → UHC-34433-48 (Scott Johnston)
Member id
UHC-34433-48
Confidence
1
Method
probabilistic
MBR-006216CLM-425529
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004014
Orphan claim re-pointed
Claims processor
CLM-423304 → UHC-41301-41 (Arjun Scott)
Member id
UHC-41301-41
Confidence
1
Method
probabilistic
MBR-013677CLM-423304
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004015
Orphan claim re-pointed
Claims processor
CLM-415077 → UHC-59750-05 (Mariana Robertson)
Member id
UHC-59750-05
Confidence
1
Method
probabilistic
MBR-014889CLM-415077
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004016
Orphan claim re-pointed
Claims processor
CLM-414590 → UHC-07734-45 (Larry Franklin)
Member id
UHC-07734-45
Confidence
0.97
Method
deterministic
MBR-007267CLM-414590
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004017
Orphan claim re-pointed
Claims processor
CLM-403125 → UHC-84056-95 (Nicholas Carter)
Member id
UHC-84056-95
Confidence
1
Method
probabilistic
MBR-015183CLM-403125
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004018
Orphan claim re-pointed
Claims processor
CLM-417283 → UHC-25481-39 (Robert Jacobs)
Member id
UHC-25481-39
Confidence
1
Method
probabilistic
MBR-018340CLM-417283
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004019
Orphan claim re-pointed
Claims processor
CLM-418059 → UHC-48631-14 (Dorothy Austin)
Member id
UHC-48631-14
Confidence
1
Method
probabilistic
MBR-006487CLM-418059
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004020
Orphan claim re-pointed
Claims processor
CLM-403178 → UHC-09651-87 (Joe Stephens)
Member id
UHC-09651-87
Confidence
1
Method
probabilistic
MBR-035777CLM-403178
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004021
Orphan claim re-pointed
Claims processor
CLM-418104 → UHC-19280-61 (Billy Vega)
Member id
UHC-19280-61
Confidence
0.97
Method
deterministic
MBR-007483CLM-418104
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004022
Orphan claim re-pointed
Claims processor
CLM-418142 → UHC-70156-56 (Alexis Ortega)
Member id
UHC-70156-56
Confidence
1
Method
probabilistic
MBR-005764CLM-418142
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004023
Orphan claim re-pointed
Claims processor
CLM-407133 → UHC-67835-89 (Sofia Thomas)
Member id
UHC-67835-89
Confidence
1
Method
probabilistic
MBR-018381CLM-407133
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004024
Orphan claim re-pointed
Claims processor
CLM-414582 → UHC-59640-98 (Angela Munoz)
Member id
UHC-59640-98
Confidence
0.97
Method
deterministic
MBR-011856CLM-414582
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004025
Orphan claim re-pointed
Claims processor
CLM-429758 → UHC-12907-68 (Betty Henderson)
Member id
UHC-12907-68
Confidence
1
Method
probabilistic
MBR-017920CLM-429758
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004026
Orphan claim re-pointed
Claims processor
CLM-413512 → UHC-68644-16 (Mary Jacobs)
Member id
UHC-68644-16
Confidence
1
Method
probabilistic
MBR-000828CLM-413512
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004027
Orphan claim re-pointed
Claims processor
CLM-429411 → UHC-13009-12 (Raymond Day)
Member id
UHC-13009-12
Confidence
0.97
Method
deterministic
MBR-021516CLM-429411
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004028
Orphan claim re-pointed
Claims processor
CLM-429304 → UHC-72399-15 (Kimberly Boyd)
Member id
UHC-72399-15
Confidence
1
Method
probabilistic
MBR-003776CLM-429304
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004029
Orphan claim re-pointed
Claims processor
CLM-408177 → UHC-31352-78 (Joyce Montgomery)
Member id
UHC-31352-78
Confidence
1
Method
probabilistic
MBR-033608CLM-408177
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004030
Orphan claim re-pointed
Claims processor
CLM-417367 → UHC-17090-46 (Joyce Medina)
Member id
UHC-17090-46
Confidence
1
Method
probabilistic
MBR-019930CLM-417367
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004031
Orphan claim re-pointed
Claims processor
CLM-423822 → UHC-86408-56 (Larry Reed)
Member id
UHC-86408-56
Confidence
0.97
Method
deterministic
MBR-017870CLM-423822
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004032
Orphan claim re-pointed
Claims processor
CLM-425417 → UHC-09047-81 (Samantha Palmer)
Member id
UHC-09047-81
Confidence
0.93
Method
probabilistic
MBR-014063CLM-425417
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004033
Orphan claim re-pointed
Claims processor
CLM-412062 → UHC-08393-09 (Emily Schultz)
Member id
UHC-08393-09
Confidence
0.92
Method
probabilistic
MBR-017879CLM-412062
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004034
Orphan claim re-pointed
Claims processor
CLM-424116 → UHC-54403-51 (Frank Lawrence)
Member id
UHC-54403-51
Confidence
1
Method
probabilistic
MBR-008217CLM-424116
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004035
Orphan claim re-pointed
Claims processor
CLM-404589 → UHC-13779-44 (Lawrence Ray)
Member id
UHC-13779-44
Confidence
0.97
Method
deterministic
MBR-007107CLM-404589
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004036
Orphan claim re-pointed
Claims processor
CLM-412553 → UHC-29225-61 (Wayne Rojas)
Member id
UHC-29225-61
Confidence
0.97
Method
deterministic
MBR-001118CLM-412553
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004037
Orphan claim re-pointed
Claims processor
CLM-402612 → UHC-08708-37 (Adam Long)
Member id
UHC-08708-37
Confidence
1
Method
probabilistic
MBR-003153CLM-402612
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004038
Orphan claim re-pointed
Claims processor
CLM-402582 → UHC-09959-89 (Philip Crawford)
Member id
UHC-09959-89
Confidence
1
Method
probabilistic
MBR-036725CLM-402582
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004039
Orphan claim re-pointed
Claims processor
CLM-416624 → UHC-37629-09 (Dennis Vargas)
Member id
UHC-37629-09
Confidence
1
Method
probabilistic
MBR-001650CLM-416624
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004040
Orphan claim re-pointed
Claims processor
CLM-415699 → UHC-13174-98 (Judy Burns)
Member id
UHC-13174-98
Confidence
1
Method
probabilistic
MBR-007661CLM-415699
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004041
Orphan claim re-pointed
Claims processor
CLM-415867 → UHC-71808-02 (George Bennett)
Member id
UHC-71808-02
Confidence
1
Method
probabilistic
MBR-010439CLM-415867
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004042
Orphan claim re-pointed
Claims processor
CLM-407001 → UHC-89166-23 (Samantha Romero)
Member id
UHC-89166-23
Confidence
0.97
Method
deterministic
MBR-019393CLM-407001
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004043
Orphan claim re-pointed
Claims processor
CLM-401493 → UHC-06635-80 (Bruce Morris)
Member id
UHC-06635-80
Confidence
1
Method
probabilistic
MBR-012796CLM-401493
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004044
Orphan claim re-pointed
Claims processor
CLM-425800 → UHC-51264-75 (Scott Ward)
Member id
UHC-51264-75
Confidence
1
Method
probabilistic
MBR-034553CLM-425800
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004045
Orphan claim re-pointed
Claims processor
CLM-430501 → UHC-52246-95 (Jose Harris)
Member id
UHC-52246-95
Confidence
1
Method
probabilistic
MBR-018454CLM-430501
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004046
Orphan claim re-pointed
Claims processor
CLM-421617 → UHC-70359-74 (Victoria Fields)
Member id
UHC-70359-74
Confidence
1
Method
probabilistic
MBR-008711CLM-421617
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004047
Orphan claim re-pointed
Claims processor
CLM-414536 → UHC-07135-27 (Sofia Anderson)
Member id
UHC-07135-27
Confidence
1
Method
probabilistic
MBR-015826CLM-414536
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004048
Orphan claim re-pointed
Claims processor
CLM-402964 → UHC-03938-67 (Ryan Bennett)
Member id
UHC-03938-67
Confidence
1
Method
probabilistic
MBR-035487CLM-402964
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004049
Orphan claim re-pointed
Claims processor
CLM-414174 → UHC-02130-07 (Henry Foster)
Member id
UHC-02130-07
Confidence
1
Method
probabilistic
MBR-038569CLM-414174
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004050
Orphan claim re-pointed
Claims processor
CLM-415161 → UHC-12236-44 (Susan Nelson)
Member id
UHC-12236-44
Confidence
1
Method
probabilistic
MBR-032083CLM-415161
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004051
Orphan claim re-pointed
Claims processor
CLM-418730 → UHC-43631-44 (Eugene Nunez)
Member id
UHC-43631-44
Confidence
0.99
Method
probabilistic
MBR-007084CLM-418730
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004052
Orphan claim re-pointed
Claims processor
CLM-432058 → UHC-84958-95 (Randy Gonzalez)
Member id
UHC-84958-95
Confidence
1
Method
probabilistic
MBR-012055CLM-432058
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004053
Orphan claim re-pointed
Claims processor
CLM-428838 → UHC-38871-63 (Sandra Stewart)
Member id
UHC-38871-63
Confidence
1
Method
probabilistic
MBR-004400CLM-428838
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004054
Orphan claim re-pointed
Claims processor
CLM-430015 → UHC-29472-90 (Timothy Gilbert)
Member id
UHC-29472-90
Confidence
1
Method
probabilistic
MBR-012880CLM-430015
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004055
Orphan claim re-pointed
Claims processor
CLM-413065 → UHC-54078-08 (Jack Watson)
Member id
UHC-54078-08
Confidence
1
Method
probabilistic
MBR-021920CLM-413065
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004056
Orphan claim re-pointed
Claims processor
CLM-407466 → UHC-39735-08 (Barbara Bell)
Member id
UHC-39735-08
Confidence
1
Method
probabilistic
MBR-025156CLM-407466
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004057
Orphan claim re-pointed
Claims processor
CLM-402864 → UHC-24915-15 (Marilyn Carpneter)
Member id
UHC-24915-15
Confidence
0.99
Method
probabilistic
MBR-026205CLM-402864
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004058
Orphan claim re-pointed
Claims processor
CLM-431608 → UHC-13335-70 (Maria Chavez)
Member id
UHC-13335-70
Confidence
1
Method
probabilistic
MBR-024923CLM-431608
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004059
Orphan claim re-pointed
Claims processor
CLM-403688 → UHC-08034-63 (Valentina Gonzalez)
Member id
UHC-08034-63
Confidence
0.98
Method
probabilistic
MBR-019114CLM-403688
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004060
Orphan claim re-pointed
Claims processor
CLM-431566 → UHC-14304-43 (Lawrence Davis)
Member id
UHC-14304-43
Confidence
1
Method
probabilistic
MBR-008606CLM-431566
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004061
Orphan claim re-pointed
Claims processor
CLM-403987 → UHC-26454-12 (Cynthia Burton)
Member id
UHC-26454-12
Confidence
1
Method
probabilistic
MBR-027683CLM-403987
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 219 of 533PreviousNext

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.