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-008212
Orphan claim re-pointed
Claims processor
CLM-403393 → UHC-56451-44 (Henry Hunter)
Member id
UHC-56451-44
Confidence
0.97
Method
deterministic
MBR-001798CLM-403393
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008213
Orphan claim re-pointed
Claims processor
CLM-403333 → UHC-81477-97 (Teresa Hayes)
Member id
UHC-81477-97
Confidence
1
Method
probabilistic
MBR-012681CLM-403333
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008214
Orphan claim re-pointed
Claims processor
CLM-431601 → UHC-83728-87 (Beverly Schultz)
Member id
UHC-83728-87
Confidence
1
Method
probabilistic
MBR-014261CLM-431601
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008215
Orphan claim re-pointed
Claims processor
CLM-401397 → UHC-52766-32 (Bryan Cruz)
Member id
UHC-52766-32
Confidence
1
Method
probabilistic
MBR-022990CLM-401397
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008216
Orphan claim re-pointed
Claims processor
CLM-417145 → UHC-10960-04 (Anna Burke)
Member id
UHC-10960-04
Confidence
1
Method
probabilistic
MBR-018737CLM-417145
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008217
Orphan claim re-pointed
Claims processor
CLM-403024 → UHC-88572-65 (Allice Wallace)
Member id
UHC-88572-65
Confidence
0.99
Method
probabilistic
MBR-022837CLM-403024
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008218
Orphan claim re-pointed
Claims processor
CLM-404198 → UHC-61850-60 (Christine Knight)
Member id
UHC-61850-60
Confidence
1
Method
probabilistic
MBR-014017CLM-404198
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008219
Orphan claim re-pointed
Claims processor
CLM-401754 → UHC-97471-75 (Pattrick Espinoza)
Member id
UHC-97471-75
Confidence
0.99
Method
probabilistic
MBR-035732CLM-401754
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008220
Orphan claim re-pointed
Claims processor
CLM-412013 → UHC-73260-83 (Samuel Adams)
Member id
UHC-73260-83
Confidence
0.85
Method
probabilistic
MBR-000656CLM-412013
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008221
Orphan claim re-pointed
Claims processor
CLM-404989 → UHC-26831-50 (Charles Lane)
Member id
UHC-26831-50
Confidence
1
Method
probabilistic
MBR-014477CLM-404989
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008222
Orphan claim re-pointed
Claims processor
CLM-406594 → UHC-02077-12 (Hiroshi Lewis)
Member id
UHC-02077-12
Confidence
1
Method
probabilistic
MBR-008672CLM-406594
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008223
Orphan claim re-pointed
Claims processor
CLM-403336 → UHC-80513-60 (Liz Robinson)
Member id
UHC-80513-60
Confidence
1
Method
probabilistic
MBR-035134CLM-403336
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008224
Orphan claim re-pointed
Claims processor
CLM-402128 → UHC-34634-77 (Emily Kennedy)
Member id
UHC-34634-77
Confidence
0.97
Method
deterministic
MBR-005460CLM-402128
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008225
Orphan claim re-pointed
Claims processor
CLM-402651 → UHC-56976-80 (Carl Rivera)
Member id
UHC-56976-80
Confidence
1
Method
probabilistic
MBR-032582CLM-402651
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008226
Orphan claim re-pointed
Claims processor
CLM-415936 → UHC-50232-64 (Billy Fuller)
Member id
UHC-50232-64
Confidence
0.95
Method
probabilistic
MBR-008452CLM-415936
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008227
Orphan claim re-pointed
Claims processor
CLM-405928 → UHC-18844-54 (Julie Peters)
Member id
UHC-18844-54
Confidence
0.85
Method
probabilistic
MBR-024184CLM-405928
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008228
Orphan claim re-pointed
Claims processor
CLM-420458 → UHC-71644-84 (Samantha Torres)
Member id
UHC-71644-84
Confidence
1
Method
probabilistic
MBR-008727CLM-420458
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008229
Orphan claim re-pointed
Claims processor
CLM-425027 → UHC-68558-75 (Jeremy Henderson)
Member id
UHC-68558-75
Confidence
1
Method
probabilistic
MBR-030798CLM-425027
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008230
Orphan claim re-pointed
Claims processor
CLM-404987 → UHC-24928-35 (Christina Kennedy)
Member id
UHC-24928-35
Confidence
1
Method
probabilistic
MBR-015350CLM-404987
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008231
Orphan claim re-pointed
Claims processor
CLM-409627 → UHC-60262-09 (Virginia Rice)
Member id
UHC-60262-09
Confidence
0.89
Method
probabilistic
MBR-016873CLM-409627
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008232
Orphan claim re-pointed
Claims processor
CLM-416765 → UHC-55195-82 (Ralph Sullivan)
Member id
UHC-55195-82
Confidence
1
Method
probabilistic
MBR-020367CLM-416765
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008233
Orphan claim re-pointed
Claims processor
CLM-402053 → UHC-50527-20 (Nancy Munoz)
Member id
UHC-50527-20
Confidence
1
Method
probabilistic
MBR-010544CLM-402053
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008234
Orphan claim re-pointed
Claims processor
CLM-431090 → UHC-36805-24 (Diana Dixon)
Member id
UHC-36805-24
Confidence
0.93
Method
probabilistic
MBR-018415CLM-431090
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008235
Orphan claim re-pointed
Claims processor
CLM-405724 → UHC-87572-94 (William Simpson)
Member id
UHC-87572-94
Confidence
1
Method
probabilistic
MBR-004399CLM-405724
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008236
Orphan claim re-pointed
Claims processor
CLM-425975 → UHC-06109-86 (Willis Edward)
Member id
UHC-06109-86
Confidence
0.98
Method
probabilistic
MBR-011961CLM-425975
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008237
Orphan claim re-pointed
Claims processor
CLM-401197 → UHC-06759-45 (Nicholas Myers)
Member id
UHC-06759-45
Confidence
1
Method
probabilistic
MBR-035742CLM-401197
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008238
Orphan claim re-pointed
Claims processor
CLM-410756 → UHC-37240-26 (Robert Lynch)
Member id
UHC-37240-26
Confidence
1
Method
probabilistic
MBR-020704CLM-410756
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008239
Orphan claim re-pointed
Claims processor
CLM-402252 → UHC-28664-92 (Nancy Bennett)
Member id
UHC-28664-92
Confidence
1
Method
probabilistic
MBR-017390CLM-402252
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008240
Orphan claim re-pointed
Claims processor
CLM-402975 → UHC-39834-94 (Philip Le)
Member id
UHC-39834-94
Confidence
1
Method
probabilistic
MBR-020582CLM-402975
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008241
Orphan claim re-pointed
Claims processor
CLM-423902 → UHC-52881-07 (Maria Nguyen)
Member id
UHC-52881-07
Confidence
0.99
Method
probabilistic
MBR-023068CLM-423902
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008242
Orphan claim re-pointed
Claims processor
CLM-415221 → UHC-73438-95 (Natahn Cole)
Member id
UHC-73438-95
Confidence
0.99
Method
probabilistic
MBR-028882CLM-415221
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008243
Orphan claim re-pointed
Claims processor
CLM-432349 → UHC-64142-84 (James Kim)
Member id
UHC-64142-84
Confidence
1
Method
probabilistic
MBR-014268CLM-432349
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008244
Orphan claim re-pointed
Claims processor
CLM-431357 → UHC-65762-69 (Judith Schultz)
Member id
UHC-65762-69
Confidence
1
Method
probabilistic
MBR-037231CLM-431357
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008245
Orphan claim re-pointed
Claims processor
CLM-410031 → UHC-67162-01 (Amber Hamilton)
Member id
UHC-67162-01
Confidence
0.97
Method
deterministic
MBR-022351CLM-410031
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008246
Orphan claim re-pointed
Claims processor
CLM-408444 → UHC-54400-55 (Stephanie Sims)
Member id
UHC-54400-55
Confidence
1
Method
probabilistic
MBR-038149CLM-408444
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008247
Orphan claim re-pointed
Claims processor
CLM-421449 → UHC-47807-89 (Emma Carroll)
Member id
UHC-47807-89
Confidence
0.97
Method
deterministic
MBR-006046CLM-421449
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008248
Orphan claim re-pointed
Claims processor
CLM-418523 → UHC-68813-64 (Evelyn Knight)
Member id
UHC-68813-64
Confidence
0.97
Method
deterministic
MBR-029560CLM-418523
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008249
Orphan claim re-pointed
Claims processor
CLM-412421 → UHC-44938-15 (Kenneth George)
Member id
UHC-44938-15
Confidence
0.97
Method
deterministic
MBR-003943CLM-412421
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008250
Orphan claim re-pointed
Claims processor
CLM-409973 → UHC-70041-90 (Tyler Sullivan)
Member id
UHC-70041-90
Confidence
1
Method
probabilistic
MBR-012059CLM-409973
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008251
Orphan claim re-pointed
Claims processor
CLM-413461 → UHC-03089-16 (Natalie Wang)
Member id
UHC-03089-16
Confidence
1
Method
probabilistic
MBR-001965CLM-413461
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008252
Orphan claim re-pointed
Claims processor
CLM-417170 → UHC-17494-94 (William Flores)
Member id
UHC-17494-94
Confidence
0.97
Method
deterministic
MBR-009370CLM-417170
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008253
Orphan claim re-pointed
Claims processor
CLM-416706 → UHC-97610-18 (Logan Wilson)
Member id
UHC-97610-18
Confidence
1
Method
probabilistic
MBR-015179CLM-416706
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008254
Orphan claim re-pointed
Claims processor
CLM-419955 → UHC-51257-13 (Joshua Jenkins)
Member id
UHC-51257-13
Confidence
0.97
Method
deterministic
MBR-010789CLM-419955
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008255
Orphan claim re-pointed
Claims processor
CLM-426798 → UHC-60300-25 (Cheryl Walker)
Member id
UHC-60300-25
Confidence
0.97
Method
deterministic
MBR-024753CLM-426798
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008256
Orphan claim re-pointed
Claims processor
CLM-428994 → UHC-35249-07 (Jack Pena)
Member id
UHC-35249-07
Confidence
1
Method
probabilistic
MBR-000992CLM-428994
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008257
Orphan claim re-pointed
Claims processor
CLM-406472 → UHC-34621-51 (Lauren Jordan)
Member id
UHC-34621-51
Confidence
1
Method
probabilistic
MBR-029458CLM-406472
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008258
Orphan claim re-pointed
Claims processor
CLM-405524 → UHC-69609-12 (Nathan Tucker)
Member id
UHC-69609-12
Confidence
1
Method
probabilistic
MBR-025540CLM-405524
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008259
Orphan claim re-pointed
Claims processor
CLM-415915 → UHC-27625-41 (Julie Rios)
Member id
UHC-27625-41
Confidence
1
Method
probabilistic
MBR-006583CLM-415915
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008260
Orphan claim re-pointed
Claims processor
CLM-406332 → UHC-44493-32 (Betty Richards)
Member id
UHC-44493-32
Confidence
0.98
Method
probabilistic
MBR-015609CLM-406332
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008261
Orphan claim re-pointed
Claims processor
CLM-426303 → UHC-31983-88 (Gloria Alvarez)
Member id
UHC-31983-88
Confidence
1
Method
probabilistic
MBR-007444CLM-426303
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 303 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.