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-004662
Orphan claim re-pointed
Claims processor
CLM-407857 → UHC-88715-46 (Ronald Espinoza)
Member id
UHC-88715-46
Confidence
1
Method
probabilistic
MBR-002670CLM-407857
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004663
Orphan claim re-pointed
Claims processor
CLM-428049 → UHC-03263-23 (Evelyn Black)
Member id
UHC-03263-23
Confidence
0.97
Method
deterministic
MBR-009885CLM-428049
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004664
Orphan claim re-pointed
Claims processor
CLM-417001 → UHC-38087-84 (Daniel Jimenez)
Member id
UHC-38087-84
Confidence
1
Method
probabilistic
MBR-007268CLM-417001
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004665
Orphan claim re-pointed
Claims processor
CLM-401823 → UHC-19090-03 (Cynthia Nelson)
Member id
UHC-19090-03
Confidence
1
Method
probabilistic
MBR-011202CLM-401823
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004666
Orphan claim re-pointed
Claims processor
CLM-400703 → UHC-32789-06 (Ethan Vargas)
Member id
UHC-32789-06
Confidence
1
Method
probabilistic
MBR-032275CLM-400703
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004667
Orphan claim re-pointed
Claims processor
CLM-427711 → UHC-66153-39 (Carol Brooks)
Member id
UHC-66153-39
Confidence
1
Method
probabilistic
MBR-026850CLM-427711
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004668
Orphan claim re-pointed
Claims processor
CLM-423228 → UHC-33176-99 (Joyce Evans)
Member id
UHC-33176-99
Confidence
1
Method
probabilistic
MBR-002437CLM-423228
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004669
Orphan claim re-pointed
Claims processor
CLM-411104 → UHC-05848-56 (Hannah Silva)
Member id
UHC-05848-56
Confidence
0.99
Method
probabilistic
MBR-011594CLM-411104
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004670
Orphan claim re-pointed
Claims processor
CLM-410562 → UHC-78828-86 (Kyle Olson)
Member id
UHC-78828-86
Confidence
0.99
Method
probabilistic
MBR-034845CLM-410562
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004671
Orphan claim re-pointed
Claims processor
CLM-418963 → UHC-23434-82 (Yuki Boyd)
Member id
UHC-23434-82
Confidence
1
Method
probabilistic
MBR-017319CLM-418963
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004672
Orphan claim re-pointed
Claims processor
CLM-430320 → UHC-98462-27 (Joyce Santos)
Member id
UHC-98462-27
Confidence
1
Method
probabilistic
MBR-008814CLM-430320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004673
Orphan claim re-pointed
Claims processor
CLM-412091 → UHC-37396-05 (Judith Stephens)
Member id
UHC-37396-05
Confidence
1
Method
probabilistic
MBR-035686CLM-412091
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004674
Orphan claim re-pointed
Claims processor
CLM-400320 → UHC-81351-96 (Edward Wilson)
Member id
UHC-81351-96
Confidence
1
Method
probabilistic
MBR-019938CLM-400320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004675
Orphan claim re-pointed
Claims processor
CLM-424374 → UHC-86900-82 (Bowman Bowman)
Member id
UHC-86900-82
Confidence
0.93
Method
probabilistic
MBR-005470CLM-424374
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004676
Orphan claim re-pointed
Claims processor
CLM-400939 → UHC-11754-69 (Roger Clark)
Member id
UHC-11754-69
Confidence
0.97
Method
deterministic
MBR-000715CLM-400939
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004677
Orphan claim re-pointed
Claims processor
CLM-406554 → UHC-78882-43 (Evelyn Green)
Member id
UHC-78882-43
Confidence
0.97
Method
deterministic
MBR-013508CLM-406554
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004678
Orphan claim re-pointed
Claims processor
CLM-401133 → UHC-91989-12 (Diana Dean)
Member id
UHC-91989-12
Confidence
0.97
Method
probabilistic
MBR-017083CLM-401133
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004679
Orphan claim re-pointed
Claims processor
CLM-431330 → UHC-60495-13 (Harold Nichols)
Member id
UHC-60495-13
Confidence
1
Method
probabilistic
MBR-003887CLM-431330
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004680
Orphan claim re-pointed
Claims processor
CLM-403036 → UHC-60766-67 (Patricia Ray)
Member id
UHC-60766-67
Confidence
0.97
Method
deterministic
MBR-019456CLM-403036
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004681
Orphan claim re-pointed
Claims processor
CLM-401112 → UHC-20583-29 (Jeff Garrett)
Member id
UHC-20583-29
Confidence
1
Method
probabilistic
MBR-035275CLM-401112
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004682
Orphan claim re-pointed
Claims processor
CLM-417152 → UHC-78337-47 (Timothy Wong)
Member id
UHC-78337-47
Confidence
1
Method
probabilistic
MBR-012430CLM-417152
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004683
Orphan claim re-pointed
Claims processor
CLM-407243 → UHC-87494-19 (Vincent Johnston)
Member id
UHC-87494-19
Confidence
1
Method
probabilistic
MBR-012560CLM-407243
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004684
Orphan claim re-pointed
Claims processor
CLM-404154 → UHC-47212-39 (Olivia Fox)
Member id
UHC-47212-39
Confidence
1
Method
probabilistic
MBR-002821CLM-404154
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004685
Orphan claim re-pointed
Claims processor
CLM-404416 → UHC-34937-60 (Alan Torres)
Member id
UHC-34937-60
Confidence
1
Method
probabilistic
MBR-027209CLM-404416
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004686
Orphan claim re-pointed
Claims processor
CLM-429651 → UHC-97105-20 (Timothy Ward)
Member id
UHC-97105-20
Confidence
0.97
Method
deterministic
MBR-030939CLM-429651
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004687
Orphan claim re-pointed
Claims processor
CLM-425914 → UHC-60558-56 (Ruth Ross)
Member id
UHC-60558-56
Confidence
1
Method
probabilistic
MBR-001545CLM-425914
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004688
Orphan claim re-pointed
Claims processor
CLM-414860 → UHC-90304-33 (Nancy Rojas)
Member id
UHC-90304-33
Confidence
1
Method
probabilistic
MBR-011210CLM-414860
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004689
Orphan claim re-pointed
Claims processor
CLM-414830 → UHC-12213-45 (Grace Coleman)
Member id
UHC-12213-45
Confidence
1
Method
probabilistic
MBR-021845CLM-414830
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004690
Orphan claim re-pointed
Claims processor
CLM-403881 → UHC-12264-39 (Timothy Reed)
Member id
UHC-12264-39
Confidence
0.97
Method
deterministic
MBR-015413CLM-403881
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004691
Orphan claim re-pointed
Claims processor
CLM-415893 → UHC-36112-57 (Diego Lane)
Member id
UHC-36112-57
Confidence
1
Method
probabilistic
MBR-005983CLM-415893
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004692
Orphan claim re-pointed
Claims processor
CLM-432810 → UHC-08687-94 (Jennifer Cunningham)
Member id
UHC-08687-94
Confidence
1
Method
probabilistic
MBR-030232CLM-432810
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004693
Orphan claim re-pointed
Claims processor
CLM-408929 → UHC-92591-12 (Kevin Powell)
Member id
UHC-92591-12
Confidence
1
Method
probabilistic
MBR-030990CLM-408929
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004694
Orphan claim re-pointed
Claims processor
CLM-429355 → UHC-35404-84 (Isabella Shaw)
Member id
UHC-35404-84
Confidence
1
Method
probabilistic
MBR-027913CLM-429355
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004695
Orphan claim re-pointed
Claims processor
CLM-409446 → UHC-98481-53 (Joan Moore)
Member id
UHC-98481-53
Confidence
0.97
Method
deterministic
MBR-003082CLM-409446
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004696
Orphan claim re-pointed
Claims processor
CLM-406801 → UHC-22406-82 (Jacob King)
Member id
UHC-22406-82
Confidence
1
Method
probabilistic
MBR-001075CLM-406801
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004697
Orphan claim re-pointed
Claims processor
CLM-419954 → UHC-51257-13 (Joshua Jenkins)
Member id
UHC-51257-13
Confidence
1
Method
probabilistic
MBR-010789CLM-419954
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004698
Orphan claim re-pointed
Claims processor
CLM-408731 → UHC-29359-29 (Kathleen Harris)
Member id
UHC-29359-29
Confidence
0.97
Method
deterministic
MBR-025419CLM-408731
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004699
Orphan claim re-pointed
Claims processor
CLM-402395 → UHC-93922-74 (Randy Harrison)
Member id
UHC-93922-74
Confidence
1
Method
probabilistic
MBR-016777CLM-402395
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004700
Orphan claim re-pointed
Claims processor
CLM-427238 → UHC-80971-11 (Russell King)
Member id
UHC-80971-11
Confidence
0.90
Method
probabilistic
MBR-009481CLM-427238
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004701
Orphan claim re-pointed
Claims processor
CLM-412070 → UHC-05080-57 (Kevin Mejia)
Member id
UHC-05080-57
Confidence
1
Method
probabilistic
MBR-037558CLM-412070
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004702
Orphan claim re-pointed
Claims processor
CLM-404909 → UHC-20206-20 (Kathryn Carpenter)
Member id
UHC-20206-20
Confidence
1
Method
probabilistic
MBR-010993CLM-404909
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004703
Orphan claim re-pointed
Claims processor
CLM-427782 → UHC-24948-24 (Karen Nichols)
Member id
UHC-24948-24
Confidence
0.99
Method
probabilistic
MBR-000555CLM-427782
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004704
Orphan claim re-pointed
Claims processor
CLM-419550 → UHC-62381-32 (Bryan Walker)
Member id
UHC-62381-32
Confidence
1
Method
probabilistic
MBR-018076CLM-419550
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004705
Orphan claim re-pointed
Claims processor
CLM-414162 → UHC-34997-70 (Marc Maldonado)
Member id
UHC-34997-70
Confidence
0.99
Method
probabilistic
MBR-027847CLM-414162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004706
Orphan claim re-pointed
Claims processor
CLM-405886 → UHC-07705-11 (Ethan Robertson)
Member id
UHC-07705-11
Confidence
1
Method
probabilistic
MBR-018236CLM-405886
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004707
Orphan claim re-pointed
Claims processor
CLM-420046 → UHC-49350-55 (Isabella Wallace)
Member id
UHC-49350-55
Confidence
1
Method
probabilistic
MBR-000514CLM-420046
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004708
Orphan claim re-pointed
Claims processor
CLM-431436 → UHC-89581-24 (Dennis Bryant)
Member id
UHC-89581-24
Confidence
1
Method
probabilistic
MBR-034351CLM-431436
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004709
Orphan claim re-pointed
Claims processor
CLM-404966 → UHC-50684-94 (Sam Miller)
Member id
UHC-50684-94
Confidence
1
Method
probabilistic
MBR-006240CLM-404966
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004710
Orphan claim re-pointed
Claims processor
CLM-422891 → UHC-71180-40 (Douglas Matthews)
Member id
UHC-71180-40
Confidence
1
Method
probabilistic
MBR-022863CLM-422891
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004711
Orphan claim re-pointed
Claims processor
CLM-431956 → UHC-42973-31 (Danielle Cruz)
Member id
UHC-42973-31
Confidence
1
Method
probabilistic
MBR-013819CLM-431956
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 232 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.