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-002390
Orphan claim re-pointed
Claims processor
CLM-429445 → UHC-81319-46 (Anna Reed)
Member id
UHC-81319-46
Confidence
1
Method
probabilistic
MBR-024442CLM-429445
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002391
Orphan claim re-pointed
Claims processor
CLM-412702 → UHC-74593-20 (Abigail Alexander)
Member id
UHC-74593-20
Confidence
1
Method
probabilistic
MBR-009673CLM-412702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002392
Orphan claim re-pointed
Claims processor
CLM-400926 → UHC-87411-86 (Priya Chen)
Member id
UHC-87411-86
Confidence
1
Method
probabilistic
MBR-019814CLM-400926
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002393
Orphan claim re-pointed
Claims processor
CLM-410360 → UHC-08481-83 (Ahmed Riley)
Member id
UHC-08481-83
Confidence
0.93
Method
probabilistic
MBR-005205CLM-410360
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002394
Orphan claim re-pointed
Claims processor
CLM-411189 → UHC-54546-12 (Dorothy Richardson)
Member id
UHC-54546-12
Confidence
1
Method
probabilistic
MBR-021749CLM-411189
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002395
Orphan claim re-pointed
Claims processor
CLM-420441 → UHC-06383-65 (Omar Allen)
Member id
UHC-06383-65
Confidence
1
Method
probabilistic
MBR-041251CLM-420441
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002396
Orphan claim re-pointed
Claims processor
CLM-411414 → UHC-09246-17 (Vincent Stewart)
Member id
UHC-09246-17
Confidence
0.93
Method
probabilistic
MBR-029577CLM-411414
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002397
Orphan claim re-pointed
Claims processor
CLM-430115 → UHC-11860-11 (Isabella Gardner)
Member id
UHC-11860-11
Confidence
1
Method
probabilistic
MBR-026618CLM-430115
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002398
Orphan claim re-pointed
Claims processor
CLM-424317 → UHC-64314-13 (Emily Ortega)
Member id
UHC-64314-13
Confidence
1
Method
probabilistic
MBR-012619CLM-424317
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002399
Orphan claim re-pointed
Claims processor
CLM-407504 → UHC-59108-59 (Julie Lee)
Member id
UHC-59108-59
Confidence
0.97
Method
deterministic
MBR-004797CLM-407504
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002400
Orphan claim re-pointed
Claims processor
CLM-408714 → UHC-67709-41 (Vincent Gordon)
Member id
UHC-67709-41
Confidence
0.97
Method
deterministic
MBR-007178CLM-408714
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002401
Orphan claim re-pointed
Claims processor
CLM-421217 → UHC-66217-85 (Randy Carlson)
Member id
UHC-66217-85
Confidence
0.97
Method
deterministic
MBR-011530CLM-421217
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002402
Orphan claim re-pointed
Claims processor
CLM-401266 → UHC-18585-05 (Marilyn Long)
Member id
UHC-18585-05
Confidence
0.97
Method
deterministic
MBR-025851CLM-401266
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002403
Orphan claim re-pointed
Claims processor
CLM-431256 → UHC-05043-11 (Andrew Lopez)
Member id
UHC-05043-11
Confidence
1
Method
probabilistic
MBR-042495CLM-431256
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002404
Orphan claim re-pointed
Claims processor
CLM-403678 → UHC-38568-32 (Frank Williamson)
Member id
UHC-38568-32
Confidence
1
Method
probabilistic
MBR-030747CLM-403678
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002405
Orphan claim re-pointed
Claims processor
CLM-404838 → UHC-08285-02 (Elizabeth Simmons)
Member id
UHC-08285-02
Confidence
1
Method
probabilistic
MBR-011390CLM-404838
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002406
Orphan claim re-pointed
Claims processor
CLM-409574 → UHC-33964-15 (Heather Welch)
Member id
UHC-33964-15
Confidence
1
Method
probabilistic
MBR-037423CLM-409574
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002407
Orphan claim re-pointed
Claims processor
CLM-405512 → UHC-96469-23 (Kathryn Lawson)
Member id
UHC-96469-23
Confidence
1
Method
probabilistic
MBR-031304CLM-405512
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002408
Orphan claim re-pointed
Claims processor
CLM-432787 → UHC-30731-01 (Deborah Rose)
Member id
UHC-30731-01
Confidence
1.00
Method
probabilistic
MBR-005250CLM-432787
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002409
Orphan claim re-pointed
Claims processor
CLM-416336 → UHC-28968-52 (Betty Soto)
Member id
UHC-28968-52
Confidence
0.97
Method
deterministic
MBR-008203CLM-416336
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002410
Orphan claim re-pointed
Claims processor
CLM-408469 → UHC-21549-44 (Joan Johnston)
Member id
UHC-21549-44
Confidence
0.97
Method
deterministic
MBR-021984CLM-408469
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002411
Orphan claim re-pointed
Claims processor
CLM-410778 → UHC-21935-35 (William Estrada)
Member id
UHC-21935-35
Confidence
1
Method
probabilistic
MBR-007788CLM-410778
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002412
Orphan claim re-pointed
Claims processor
CLM-426453 → UHC-13952-43 (Margaret Weaver)
Member id
UHC-13952-43
Confidence
1
Method
probabilistic
MBR-000298CLM-426453
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002413
Orphan claim re-pointed
Claims processor
CLM-412643 → UHC-23556-43 (Andrea Sanders)
Member id
UHC-23556-43
Confidence
1
Method
probabilistic
MBR-016426CLM-412643
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002414
Orphan claim re-pointed
Claims processor
CLM-403331 → UHC-81477-97 (Teresa Hayes)
Member id
UHC-81477-97
Confidence
1
Method
probabilistic
MBR-012681CLM-403331
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002415
Orphan claim re-pointed
Claims processor
CLM-412388 → UHC-11519-51 (Linda Perkins)
Member id
UHC-11519-51
Confidence
1
Method
probabilistic
MBR-033623CLM-412388
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002416
Orphan claim re-pointed
Claims processor
CLM-421379 → UHC-70202-76 (Dylan Bowman)
Member id
UHC-70202-76
Confidence
1
Method
probabilistic
MBR-020558CLM-421379
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002417
Orphan claim re-pointed
Claims processor
CLM-403800 → UHC-30857-34 (Frances Jacobs)
Member id
UHC-30857-34
Confidence
1
Method
probabilistic
MBR-001116CLM-403800
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002418
Orphan claim re-pointed
Claims processor
CLM-421854 → UHC-38780-55 (Eric Watson)
Member id
UHC-38780-55
Confidence
1
Method
probabilistic
MBR-020258CLM-421854
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002419
Orphan claim re-pointed
Claims processor
CLM-403979 → UHC-51075-25 (Timothy Arnold)
Member id
UHC-51075-25
Confidence
1
Method
probabilistic
MBR-004054CLM-403979
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002420
Orphan claim re-pointed
Claims processor
CLM-417990 → UHC-32000-97 (Jennifer West)
Member id
UHC-32000-97
Confidence
1
Method
probabilistic
MBR-011582CLM-417990
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002421
Orphan claim re-pointed
Claims processor
CLM-431770 → UHC-27459-40 (Jose Rodriguez)
Member id
UHC-27459-40
Confidence
1
Method
probabilistic
MBR-004506CLM-431770
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002422
Orphan claim re-pointed
Claims processor
CLM-410974 → UHC-37259-61 (Nicholas Aguilar)
Member id
UHC-37259-61
Confidence
1
Method
probabilistic
MBR-020408CLM-410974
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002423
Orphan claim re-pointed
Claims processor
CLM-424015 → UHC-74572-28 (Ethan Rose)
Member id
UHC-74572-28
Confidence
1
Method
probabilistic
MBR-020977CLM-424015
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002424
Orphan claim re-pointed
Claims processor
CLM-430684 → UHC-45678-94 (Sophia Black)
Member id
UHC-45678-94
Confidence
0.99
Method
probabilistic
MBR-018916CLM-430684
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002425
Orphan claim re-pointed
Claims processor
CLM-428184 → UHC-06932-65 (Dylan Greene)
Member id
UHC-06932-65
Confidence
1
Method
probabilistic
MBR-016525CLM-428184
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002426
Orphan claim re-pointed
Claims processor
CLM-431649 → UHC-75916-95 (Samuel Ryan)
Member id
UHC-75916-95
Confidence
1
Method
probabilistic
MBR-026329CLM-431649
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002427
Orphan claim re-pointed
Claims processor
CLM-402196 → UHC-02849-78 (Susan Morris)
Member id
UHC-02849-78
Confidence
1
Method
probabilistic
MBR-013825CLM-402196
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002428
Orphan claim re-pointed
Claims processor
CLM-421461 → UHC-12228-04 (Juan Kelly)
Member id
UHC-12228-04
Confidence
1
Method
probabilistic
MBR-019800CLM-421461
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002429
Orphan claim re-pointed
Claims processor
CLM-408227 → UHC-35780-70 (Julia Carroll)
Member id
UHC-35780-70
Confidence
1
Method
probabilistic
MBR-000875CLM-408227
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002430
Orphan claim re-pointed
Claims processor
CLM-430199 → UHC-22797-90 (Philip Olson)
Member id
UHC-22797-90
Confidence
0.97
Method
deterministic
MBR-019656CLM-430199
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002431
Orphan claim re-pointed
Claims processor
CLM-413884 → UHC-33252-46 (Patricia Patel)
Member id
UHC-33252-46
Confidence
0.98
Method
probabilistic
MBR-005207CLM-413884
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002432
Orphan claim re-pointed
Claims processor
CLM-409002 → UHC-19821-29 (Alice Reid)
Member id
UHC-19821-29
Confidence
1
Method
probabilistic
MBR-019009CLM-409002
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002433
Orphan claim re-pointed
Claims processor
CLM-401518 → UHC-77889-07 (Ronald Gonzales)
Member id
UHC-77889-07
Confidence
1
Method
probabilistic
MBR-002886CLM-401518
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002434
Orphan claim re-pointed
Claims processor
CLM-414728 → UHC-82089-15 (Janet Munoz)
Member id
UHC-82089-15
Confidence
1
Method
probabilistic
MBR-017876CLM-414728
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002435
Orphan claim re-pointed
Claims processor
CLM-402974 → UHC-03290-88 (Fatima Webb)
Member id
UHC-03290-88
Confidence
0.93
Method
probabilistic
MBR-002681CLM-402974
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002436
Orphan claim re-pointed
Claims processor
CLM-414815 → UHC-49101-83 (Bruce Hansen)
Member id
UHC-49101-83
Confidence
1
Method
probabilistic
MBR-006523CLM-414815
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002437
Orphan claim re-pointed
Claims processor
CLM-422173 → UHC-28139-43 (Lori Robinson)
Member id
UHC-28139-43
Confidence
1
Method
probabilistic
MBR-003532CLM-422173
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002438
Orphan claim re-pointed
Claims processor
CLM-431156 → UHC-77450-32 (Helen Munoz)
Member id
UHC-77450-32
Confidence
1
Method
probabilistic
MBR-000194CLM-431156
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002439
Orphan claim re-pointed
Claims processor
CLM-402353 → UHC-78850-61 (Ralph Woods)
Member id
UHC-78850-61
Confidence
1
Method
probabilistic
MBR-014025CLM-402353
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 22 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.