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-006612
Orphan claim re-pointed
Claims processor
CLM-423914 → UHC-98691-32 (Janice Kelly)
Member id
UHC-98691-32
Confidence
1
Method
probabilistic
MBR-016341CLM-423914
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006613
Orphan claim re-pointed
Claims processor
CLM-413808 → UHC-32902-31 (Sarah Oliver)
Member id
UHC-32902-31
Confidence
1
Method
probabilistic
MBR-015994CLM-413808
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006614
Orphan claim re-pointed
Claims processor
CLM-404919 → UHC-88136-88 (Cheryl Bryant)
Member id
UHC-88136-88
Confidence
1
Method
probabilistic
MBR-027193CLM-404919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006615
Orphan claim re-pointed
Claims processor
CLM-426928 → UHC-66065-50 (Sean Howell)
Member id
UHC-66065-50
Confidence
1
Method
probabilistic
MBR-029859CLM-426928
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006616
Orphan claim re-pointed
Claims processor
CLM-402192 → UHC-57261-42 (Lawrence Morris)
Member id
UHC-57261-42
Confidence
0.97
Method
deterministic
MBR-026652CLM-402192
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006617
Orphan claim re-pointed
Claims processor
CLM-432096 → UHC-53955-09 (Wei Marshall)
Member id
UHC-53955-09
Confidence
0.97
Method
deterministic
MBR-016064CLM-432096
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006618
Orphan claim re-pointed
Claims processor
CLM-426950 → UHC-06715-98 (Karen Powell)
Member id
UHC-06715-98
Confidence
1
Method
probabilistic
MBR-006911CLM-426950
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006619
Orphan claim re-pointed
Claims processor
CLM-404705 → UHC-81150-79 (Sean Marquez)
Member id
UHC-81150-79
Confidence
1
Method
probabilistic
MBR-001394CLM-404705
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006620
Orphan claim re-pointed
Claims processor
CLM-431298 → UHC-31999-53 (Olivia Riley)
Member id
UHC-31999-53
Confidence
0.97
Method
deterministic
MBR-034072CLM-431298
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006621
Orphan claim re-pointed
Claims processor
CLM-427670 → UHC-29582-45 (Jonathan Flores)
Member id
UHC-29582-45
Confidence
1
Method
probabilistic
MBR-003432CLM-427670
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006622
Orphan claim re-pointed
Claims processor
CLM-420403 → UHC-51717-73 (Carol Ortega)
Member id
UHC-51717-73
Confidence
1
Method
probabilistic
MBR-013484CLM-420403
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006623
Orphan claim re-pointed
Claims processor
CLM-401418 → UHC-98347-36 (Catherine Marshall)
Member id
UHC-98347-36
Confidence
0.97
Method
deterministic
MBR-019740CLM-401418
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006624
Orphan claim re-pointed
Claims processor
CLM-414400 → UHC-71463-79 (Amanda Olson)
Member id
UHC-71463-79
Confidence
0.93
Method
probabilistic
MBR-036080CLM-414400
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006625
Orphan claim re-pointed
Claims processor
CLM-417751 → UHC-91470-77 (Heather Pierce)
Member id
UHC-91470-77
Confidence
0.93
Method
probabilistic
MBR-028120CLM-417751
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006626
Orphan claim re-pointed
Claims processor
CLM-409014 → UHC-18863-18 (Bradley Bell)
Member id
UHC-18863-18
Confidence
0.99
Method
probabilistic
MBR-002693CLM-409014
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006627
Orphan claim re-pointed
Claims processor
CLM-401255 → UHC-04938-69 (Brandon Adams)
Member id
UHC-04938-69
Confidence
1
Method
probabilistic
MBR-008928CLM-401255
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006628
Orphan claim re-pointed
Claims processor
CLM-429473 → UHC-57140-31 (Albert Rice)
Member id
UHC-57140-31
Confidence
1
Method
probabilistic
MBR-010808CLM-429473
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006629
Orphan claim re-pointed
Claims processor
CLM-409091 → UHC-22422-34 (Kimberly Jordan)
Member id
UHC-22422-34
Confidence
1
Method
probabilistic
MBR-008692CLM-409091
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006630
Orphan claim re-pointed
Claims processor
CLM-413365 → UHC-02982-41 (Kevin Vasquez)
Member id
UHC-02982-41
Confidence
1
Method
probabilistic
MBR-005112CLM-413365
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006631
Orphan claim re-pointed
Claims processor
CLM-423860 → UHC-09978-13 (Billy Brown)
Member id
UHC-09978-13
Confidence
0.94
Method
probabilistic
MBR-012657CLM-423860
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006632
Orphan claim re-pointed
Claims processor
CLM-411137 → UHC-73026-62 (Vincent Larson)
Member id
UHC-73026-62
Confidence
1
Method
probabilistic
MBR-005719CLM-411137
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006633
Orphan claim re-pointed
Claims processor
CLM-407149 → UHC-38319-19 (Hannah Rose)
Member id
UHC-38319-19
Confidence
0.97
Method
deterministic
MBR-006459CLM-407149
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006634
Orphan claim re-pointed
Claims processor
CLM-424361 → UHC-15386-32 (Pamela Hayes)
Member id
UHC-15386-32
Confidence
1
Method
probabilistic
MBR-006716CLM-424361
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006635
Orphan claim re-pointed
Claims processor
CLM-430867 → UHC-22981-87 (Dennis Brown)
Member id
UHC-22981-87
Confidence
1
Method
probabilistic
MBR-016906CLM-430867
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006636
Orphan claim re-pointed
Claims processor
CLM-405289 → UHC-97566-56 (Catherine Myers)
Member id
UHC-97566-56
Confidence
0.99
Method
probabilistic
MBR-008124CLM-405289
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006637
Orphan claim re-pointed
Claims processor
CLM-408585 → UHC-24341-03 (Doris West)
Member id
UHC-24341-03
Confidence
1
Method
probabilistic
MBR-013691CLM-408585
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006638
Orphan claim re-pointed
Claims processor
CLM-425638 → UHC-17486-97 (Heather Meyer)
Member id
UHC-17486-97
Confidence
1
Method
probabilistic
MBR-028285CLM-425638
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006639
Orphan claim re-pointed
Claims processor
CLM-413176 → UHC-47386-60 (Kathleen Simpson)
Member id
UHC-47386-60
Confidence
1
Method
probabilistic
MBR-005206CLM-413176
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006640
Orphan claim re-pointed
Claims processor
CLM-424954 → UHC-35917-23 (Nancy Rios)
Member id
UHC-35917-23
Confidence
0.97
Method
deterministic
MBR-019101CLM-424954
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006641
Orphan claim re-pointed
Claims processor
CLM-411549 → UHC-08946-13 (Gabriel Nguyen)
Member id
UHC-08946-13
Confidence
1.00
Method
probabilistic
MBR-003510CLM-411549
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006642
Orphan claim re-pointed
Claims processor
CLM-405365 → UHC-25287-21 (Elijah Brooks)
Member id
UHC-25287-21
Confidence
1
Method
probabilistic
MBR-039870CLM-405365
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006643
Orphan claim re-pointed
Claims processor
CLM-424088 → UHC-89750-63 (Tyler Silva)
Member id
UHC-89750-63
Confidence
1
Method
probabilistic
MBR-019982CLM-424088
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006644
Orphan claim re-pointed
Claims processor
CLM-407148 → UHC-38319-19 (Hannah Rose)
Member id
UHC-38319-19
Confidence
0.97
Method
deterministic
MBR-006459CLM-407148
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006645
Orphan claim re-pointed
Claims processor
CLM-416081 → UHC-80041-28 (Angela Bailey)
Member id
UHC-80041-28
Confidence
0.98
Method
probabilistic
MBR-028689CLM-416081
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006646
Orphan claim re-pointed
Claims processor
CLM-424043 → UHC-20832-08 (Alexander Robertson)
Member id
UHC-20832-08
Confidence
1
Method
probabilistic
MBR-007934CLM-424043
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006647
Orphan claim re-pointed
Claims processor
CLM-427906 → UHC-74207-75 (Emma Clark)
Member id
UHC-74207-75
Confidence
0.99
Method
probabilistic
MBR-004855CLM-427906
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006648
Orphan claim re-pointed
Claims processor
CLM-415704 → UHC-25722-63 (Juan Williams)
Member id
UHC-25722-63
Confidence
1
Method
probabilistic
MBR-019216CLM-415704
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006649
Orphan claim re-pointed
Claims processor
CLM-432140 → UHC-97290-31 (Roger Wang)
Member id
UHC-97290-31
Confidence
0.99
Method
probabilistic
MBR-007914CLM-432140
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006650
Orphan claim re-pointed
Claims processor
CLM-401482 → UHC-24743-25 (Ann Harris)
Member id
UHC-24743-25
Confidence
1
Method
probabilistic
MBR-018289CLM-401482
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006651
Orphan claim re-pointed
Claims processor
CLM-413915 → UHC-01218-90 (Dorothy Woods)
Member id
UHC-01218-90
Confidence
1
Method
probabilistic
MBR-005369CLM-413915
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006652
Orphan claim re-pointed
Claims processor
CLM-418112 → UHC-95097-30 (Arthur Oliver)
Member id
UHC-95097-30
Confidence
1
Method
probabilistic
MBR-003391CLM-418112
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006653
Orphan claim re-pointed
Claims processor
CLM-413549 → UHC-46841-03 (Rachel Richardson)
Member id
UHC-46841-03
Confidence
1
Method
probabilistic
MBR-020287CLM-413549
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006654
Orphan claim re-pointed
Claims processor
CLM-427301 → UHC-17983-86 (Logan Vargas)
Member id
UHC-17983-86
Confidence
1
Method
probabilistic
MBR-020001CLM-427301
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006655
Orphan claim re-pointed
Claims processor
CLM-409967 → UHC-08632-94 (Henry Espinoza)
Member id
UHC-08632-94
Confidence
0.99
Method
probabilistic
MBR-014561CLM-409967
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006656
Orphan claim re-pointed
Claims processor
CLM-405958 → UHC-58253-49 (Rachel West)
Member id
UHC-58253-49
Confidence
1
Method
probabilistic
MBR-023905CLM-405958
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006657
Orphan claim re-pointed
Claims processor
CLM-415987 → UHC-27825-83 (Patrick Fisher)
Member id
UHC-27825-83
Confidence
1
Method
probabilistic
MBR-008563CLM-415987
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006658
Orphan claim re-pointed
Claims processor
CLM-416471 → UHC-76175-26 (Donna Burton)
Member id
UHC-76175-26
Confidence
1
Method
probabilistic
MBR-018799CLM-416471
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006659
Orphan claim re-pointed
Claims processor
CLM-420370 → UHC-64022-98 (Albert Moreno)
Member id
UHC-64022-98
Confidence
1
Method
probabilistic
MBR-016597CLM-420370
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006660
Orphan claim re-pointed
Claims processor
CLM-410371 → UHC-41438-71 (Ralph Jimenez)
Member id
UHC-41438-71
Confidence
1
Method
probabilistic
MBR-010395CLM-410371
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006661
Orphan claim re-pointed
Claims processor
CLM-406684 → UHC-79617-30 (Virginia Hoffman)
Member id
UHC-79617-30
Confidence
0.97
Method
deterministic
MBR-012358CLM-406684
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 271 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.