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-007062
Orphan claim re-pointed
Claims processor
CLM-425358 → UHC-45106-07 (Nathan Patterson)
Member id
UHC-45106-07
Confidence
1
Method
probabilistic
MBR-012916CLM-425358
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007063
Orphan claim re-pointed
Claims processor
CLM-429485 → UHC-15796-58 (Stephen King)
Member id
UHC-15796-58
Confidence
1
Method
probabilistic
MBR-002628CLM-429485
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007064
Orphan claim re-pointed
Claims processor
CLM-412331 → UHC-02947-44 (Carolyn Garrett)
Member id
UHC-02947-44
Confidence
0.97
Method
deterministic
MBR-013924CLM-412331
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007065
Orphan claim re-pointed
Claims processor
CLM-418154 → UHC-63645-91 (Harold Mejia)
Member id
UHC-63645-91
Confidence
1
Method
probabilistic
MBR-009130CLM-418154
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007066
Orphan claim re-pointed
Claims processor
CLM-407420 → UHC-15937-04 (Rachel Munoz)
Member id
UHC-15937-04
Confidence
1
Method
probabilistic
MBR-009939CLM-407420
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007067
Orphan claim re-pointed
Claims processor
CLM-409307 → UHC-30271-36 (Emma Estrada)
Member id
UHC-30271-36
Confidence
1
Method
probabilistic
MBR-006207CLM-409307
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007068
Orphan claim re-pointed
Claims processor
CLM-421358 → UHC-19063-42 (Larry Bradley)
Member id
UHC-19063-42
Confidence
0.99
Method
probabilistic
MBR-038211CLM-421358
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007069
Orphan claim re-pointed
Claims processor
CLM-412428 → UHC-62361-29 (Jason Wang)
Member id
UHC-62361-29
Confidence
1
Method
probabilistic
MBR-025813CLM-412428
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007070
Orphan claim re-pointed
Claims processor
CLM-421703 → UHC-25714-67 (Paul Bryant)
Member id
UHC-25714-67
Confidence
0.93
Method
probabilistic
MBR-019832CLM-421703
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007071
Orphan claim re-pointed
Claims processor
CLM-425859 → UHC-68692-18 (Donna Reed)
Member id
UHC-68692-18
Confidence
1
Method
probabilistic
MBR-001647CLM-425859
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007072
Orphan claim re-pointed
Claims processor
CLM-428032 → UHC-28017-01 (Lawrence Johnston)
Member id
UHC-28017-01
Confidence
1
Method
probabilistic
MBR-022857CLM-428032
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007073
Orphan claim re-pointed
Claims processor
CLM-411399 → UHC-75380-43 (Julie Ortega)
Member id
UHC-75380-43
Confidence
0.93
Method
probabilistic
MBR-019990CLM-411399
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007074
Orphan claim re-pointed
Claims processor
CLM-414702 → UHC-66762-67 (Cynthia Green)
Member id
UHC-66762-67
Confidence
1.00
Method
probabilistic
MBR-011352CLM-414702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007075
Orphan claim re-pointed
Claims processor
CLM-406650 → UHC-76743-89 (Walter Patel)
Member id
UHC-76743-89
Confidence
1
Method
probabilistic
MBR-026737CLM-406650
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007076
Orphan claim re-pointed
Claims processor
CLM-405020 → UHC-26434-29 (Abigail George)
Member id
UHC-26434-29
Confidence
1
Method
probabilistic
MBR-007370CLM-405020
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007077
Orphan claim re-pointed
Claims processor
CLM-401399 → UHC-65311-64 (Gabriel Robertson)
Member id
UHC-65311-64
Confidence
1
Method
probabilistic
MBR-001760CLM-401399
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007078
Orphan claim re-pointed
Claims processor
CLM-427932 → UHC-47608-49 (Jack Taylor)
Member id
UHC-47608-49
Confidence
0.97
Method
deterministic
MBR-025980CLM-427932
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007079
Orphan claim re-pointed
Claims processor
CLM-408629 → UHC-11208-80 (Theresa Munoz)
Member id
UHC-11208-80
Confidence
1
Method
probabilistic
MBR-004379CLM-408629
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007080
Orphan claim re-pointed
Claims processor
CLM-405392 → UHC-81436-54 (Wei Martinez)
Member id
UHC-81436-54
Confidence
0.97
Method
deterministic
MBR-006095CLM-405392
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007081
Orphan claim re-pointed
Claims processor
CLM-420510 → UHC-80101-02 (Arjun White)
Member id
UHC-80101-02
Confidence
0.98
Method
probabilistic
MBR-008780CLM-420510
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007082
Orphan claim re-pointed
Claims processor
CLM-410241 → UHC-81933-20 (Scott Lynch)
Member id
UHC-81933-20
Confidence
1
Method
probabilistic
MBR-032627CLM-410241
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007083
Orphan claim re-pointed
Claims processor
CLM-420576 → UHC-73258-28 (Willie Daniels)
Member id
UHC-73258-28
Confidence
1
Method
probabilistic
MBR-008733CLM-420576
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007084
Orphan claim re-pointed
Claims processor
CLM-432321 → UHC-58364-11 (Cheryl Obrien)
Member id
UHC-58364-11
Confidence
0.99
Method
probabilistic
MBR-002556CLM-432321
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007085
Orphan claim re-pointed
Claims processor
CLM-417848 → UHC-78224-40 (Sean Castro)
Member id
UHC-78224-40
Confidence
0.94
Method
probabilistic
MBR-001542CLM-417848
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007086
Orphan claim re-pointed
Claims processor
CLM-418734 → UHC-20070-18 (Justin Martinez)
Member id
UHC-20070-18
Confidence
1
Method
probabilistic
MBR-010191CLM-418734
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007087
Orphan claim re-pointed
Claims processor
CLM-408973 → UHC-27676-63 (Nicole Sullivan)
Member id
UHC-27676-63
Confidence
0.97
Method
deterministic
MBR-029876CLM-408973
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007088
Orphan claim re-pointed
Claims processor
CLM-409737 → UHC-80139-48 (Scott Howell)
Member id
UHC-80139-48
Confidence
1
Method
probabilistic
MBR-019713CLM-409737
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007089
Orphan claim re-pointed
Claims processor
CLM-408767 → UHC-60553-01 (Amy Young)
Member id
UHC-60553-01
Confidence
1
Method
probabilistic
MBR-008531CLM-408767
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007090
Orphan claim re-pointed
Claims processor
CLM-408372 → UHC-17896-01 (Anna Coleman)
Member id
UHC-17896-01
Confidence
0.99
Method
probabilistic
MBR-012572CLM-408372
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007091
Orphan claim re-pointed
Claims processor
CLM-414886 → UHC-48337-47 (David Ryan)
Member id
UHC-48337-47
Confidence
1
Method
probabilistic
MBR-020233CLM-414886
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007092
Orphan claim re-pointed
Claims processor
CLM-413761 → UHC-84921-80 (Andrea Wilson)
Member id
UHC-84921-80
Confidence
1
Method
probabilistic
MBR-006423CLM-413761
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007093
Orphan claim re-pointed
Claims processor
CLM-400088 → UHC-61834-78 (Wei Garza)
Member id
UHC-61834-78
Confidence
1
Method
probabilistic
MBR-019651CLM-400088
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007094
Orphan claim re-pointed
Claims processor
CLM-429293 → UHC-35294-47 (Ethan Ruiz)
Member id
UHC-35294-47
Confidence
1
Method
probabilistic
MBR-009820CLM-429293
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007095
Orphan claim re-pointed
Claims processor
CLM-405667 → UHC-41947-43 (Jacqueline Fowler)
Member id
UHC-41947-43
Confidence
1
Method
probabilistic
MBR-037989CLM-405667
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007096
Orphan claim re-pointed
Claims processor
CLM-429225 → UHC-11820-74 (Steven Wheeler)
Member id
UHC-11820-74
Confidence
1
Method
probabilistic
MBR-037825CLM-429225
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007097
Orphan claim re-pointed
Claims processor
CLM-412634 → UHC-56622-34 (Mateo Estrada)
Member id
UHC-56622-34
Confidence
1
Method
probabilistic
MBR-006530CLM-412634
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007098
Orphan claim re-pointed
Claims processor
CLM-425606 → UHC-75343-29 (Lauren Wang)
Member id
UHC-75343-29
Confidence
1
Method
probabilistic
MBR-000146CLM-425606
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007099
Orphan claim re-pointed
Claims processor
CLM-409255 → UHC-15357-52 (Douglas Harris)
Member id
UHC-15357-52
Confidence
0.97
Method
deterministic
MBR-036271CLM-409255
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007100
Orphan claim re-pointed
Claims processor
CLM-402800 → UHC-70158-96 (Timothy Wilson)
Member id
UHC-70158-96
Confidence
1
Method
probabilistic
MBR-026366CLM-402800
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007101
Orphan claim re-pointed
Claims processor
CLM-423088 → UHC-83540-64 (Emily Fox)
Member id
UHC-83540-64
Confidence
0.93
Method
probabilistic
MBR-036884CLM-423088
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007102
Orphan claim re-pointed
Claims processor
CLM-415521 → UHC-33418-96 (Bruce Reynolds)
Member id
UHC-33418-96
Confidence
1
Method
probabilistic
MBR-023552CLM-415521
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007103
Orphan claim re-pointed
Claims processor
CLM-429559 → UHC-66040-77 (Bruce Alexander)
Member id
UHC-66040-77
Confidence
1
Method
probabilistic
MBR-025301CLM-429559
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007104
Orphan claim re-pointed
Claims processor
CLM-421335 → UHC-16004-64 (Maria Spencer)
Member id
UHC-16004-64
Confidence
0.97
Method
deterministic
MBR-004414CLM-421335
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007105
Orphan claim re-pointed
Claims processor
CLM-415775 → UHC-50584-31 (Sara Estrada)
Member id
UHC-50584-31
Confidence
0.99
Method
probabilistic
MBR-003264CLM-415775
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007106
Orphan claim re-pointed
Claims processor
CLM-401317 → UHC-47254-57 (Marilyn Miller)
Member id
UHC-47254-57
Confidence
0.97
Method
deterministic
MBR-001763CLM-401317
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007107
Orphan claim re-pointed
Claims processor
CLM-431657 → UHC-98030-27 (Billy Fisher)
Member id
UHC-98030-27
Confidence
1
Method
probabilistic
MBR-004925CLM-431657
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007108
Orphan claim re-pointed
Claims processor
CLM-400988 → UHC-53067-61 (Gloria Moore)
Member id
UHC-53067-61
Confidence
1
Method
probabilistic
MBR-009800CLM-400988
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007109
Orphan claim re-pointed
Claims processor
CLM-417531 → UHC-30073-49 (Jeffrey Singh)
Member id
UHC-30073-49
Confidence
1
Method
probabilistic
MBR-015868CLM-417531
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007110
Orphan claim re-pointed
Claims processor
CLM-410001 → UHC-04817-13 (Priya McDonald)
Member id
UHC-04817-13
Confidence
1
Method
probabilistic
MBR-007102CLM-410001
Executed
resolution_agent
2026-10-22 12:47:23
ACT-007111
Orphan claim re-pointed
Claims processor
CLM-402212 → UHC-27777-76 (Edward Garrett)
Member id
UHC-27777-76
Confidence
1
Method
probabilistic
MBR-038812CLM-402212
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 280 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.