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-008762
Orphan claim re-pointed
Claims processor
CLM-418066 → UHC-23538-88 (Charls Weber)
Member id
UHC-23538-88
Confidence
0.99
Method
probabilistic
MBR-032027CLM-418066
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008763
Orphan claim re-pointed
Claims processor
CLM-409186 → UHC-17106-67 (Jack Delgado)
Member id
UHC-17106-67
Confidence
1
Method
probabilistic
MBR-011445CLM-409186
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008764
Orphan claim re-pointed
Claims processor
CLM-424712 → UHC-07807-62 (Dylan Parker)
Member id
UHC-07807-62
Confidence
0.99
Method
probabilistic
MBR-028448CLM-424712
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008765
Orphan claim re-pointed
Claims processor
CLM-402861 → UHC-90305-60 (Randy Austin)
Member id
UHC-90305-60
Confidence
1
Method
probabilistic
MBR-010979CLM-402861
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008766
Orphan claim re-pointed
Claims processor
CLM-426500 → UHC-67391-14 (Gregory Alvarez)
Member id
UHC-67391-14
Confidence
0.92
Method
probabilistic
MBR-040482CLM-426500
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008767
Orphan claim re-pointed
Claims processor
CLM-430945 → UHC-05141-79 (Richard Park)
Member id
UHC-05141-79
Confidence
1
Method
probabilistic
MBR-005186CLM-430945
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008768
Orphan claim re-pointed
Claims processor
CLM-427412 → UHC-79354-74 (Raymond Fox)
Member id
UHC-79354-74
Confidence
1
Method
probabilistic
MBR-008421CLM-427412
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008769
Orphan claim re-pointed
Claims processor
CLM-426748 → UHC-68092-51 (Daniel Bennett)
Member id
UHC-68092-51
Confidence
1
Method
probabilistic
MBR-042966CLM-426748
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008770
Orphan claim re-pointed
Claims processor
CLM-402524 → UHC-83888-95 (Dennis Lopez)
Member id
UHC-83888-95
Confidence
0.97
Method
deterministic
MBR-018091CLM-402524
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008771
Orphan claim re-pointed
Claims processor
CLM-418802 → UHC-57518-79 (Megan Perkins)
Member id
UHC-57518-79
Confidence
1
Method
probabilistic
MBR-045386CLM-418802
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008772
Orphan claim re-pointed
Claims processor
CLM-402553 → UHC-32025-84 (Harold Soto)
Member id
UHC-32025-84
Confidence
1
Method
probabilistic
MBR-001066CLM-402553
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008773
Orphan claim re-pointed
Claims processor
CLM-424399 → UHC-38186-66 (Gregory Kelley)
Member id
UHC-38186-66
Confidence
1
Method
probabilistic
MBR-022047CLM-424399
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008774
Orphan claim re-pointed
Claims processor
CLM-424441 → UHC-47030-79 (Kenneth Daniels)
Member id
UHC-47030-79
Confidence
1
Method
probabilistic
MBR-044749CLM-424441
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008775
Orphan claim re-pointed
Claims processor
CLM-421256 → UHC-33766-77 (Brian Cook)
Member id
UHC-33766-77
Confidence
1
Method
probabilistic
MBR-006526CLM-421256
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008776
Orphan claim re-pointed
Claims processor
CLM-431193 → UHC-10276-84 (Jordan Banks)
Member id
UHC-10276-84
Confidence
1
Method
probabilistic
MBR-023929CLM-431193
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008777
Orphan claim re-pointed
Claims processor
CLM-411882 → UHC-09142-06 (Ahmed Hicks)
Member id
UHC-09142-06
Confidence
0.99
Method
probabilistic
MBR-035071CLM-411882
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008778
Orphan claim re-pointed
Claims processor
CLM-428998 → UHC-35790-95 (Andrea Morrison)
Member id
UHC-35790-95
Confidence
1
Method
probabilistic
MBR-017878CLM-428998
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008779
Orphan claim re-pointed
Claims processor
CLM-413359 → UHC-04677-70 (Ronald Padilla)
Member id
UHC-04677-70
Confidence
1
Method
probabilistic
MBR-021175CLM-413359
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008780
Orphan claim re-pointed
Claims processor
CLM-409868 → UHC-94718-70 (Santiago Garza)
Member id
UHC-94718-70
Confidence
1
Method
probabilistic
MBR-021244CLM-409868
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008781
Orphan claim re-pointed
Claims processor
CLM-419253 → UHC-14938-22 (Andrea King)
Member id
UHC-14938-22
Confidence
1
Method
probabilistic
MBR-007281CLM-419253
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008782
Orphan claim re-pointed
Claims processor
CLM-426679 → UHC-31365-37 (Rachel Fowler)
Member id
UHC-31365-37
Confidence
0.97
Method
deterministic
MBR-015846CLM-426679
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008783
Orphan claim re-pointed
Claims processor
CLM-431101 → UHC-46389-21 (Kimberly Baker)
Member id
UHC-46389-21
Confidence
1.00
Method
probabilistic
MBR-019181CLM-431101
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008784
Orphan claim re-pointed
Claims processor
CLM-400202 → UHC-84816-78 (Isabella Fernandez)
Member id
UHC-84816-78
Confidence
1
Method
probabilistic
MBR-002025CLM-400202
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008785
Orphan claim re-pointed
Claims processor
CLM-404921 → UHC-04919-14 (Jessica Torres)
Member id
UHC-04919-14
Confidence
0.91
Method
probabilistic
MBR-011322CLM-404921
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008786
Orphan claim re-pointed
Claims processor
CLM-408432 → UHC-12890-38 (Denise Gordon)
Member id
UHC-12890-38
Confidence
0.97
Method
deterministic
MBR-005697CLM-408432
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008787
Orphan claim re-pointed
Claims processor
CLM-403166 → UHC-20636-06 (Ann Gilbert)
Member id
UHC-20636-06
Confidence
1
Method
probabilistic
MBR-004007CLM-403166
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008788
Orphan claim re-pointed
Claims processor
CLM-400089 → UHC-61834-78 (Wei Garza)
Member id
UHC-61834-78
Confidence
1
Method
probabilistic
MBR-019651CLM-400089
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008789
Orphan claim re-pointed
Claims processor
CLM-425479 → UHC-41763-34 (Virginia Graham)
Member id
UHC-41763-34
Confidence
1
Method
probabilistic
MBR-007277CLM-425479
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008790
Orphan claim re-pointed
Claims processor
CLM-422482 → UHC-65025-01 (Bobby Wilson)
Member id
UHC-65025-01
Confidence
1
Method
probabilistic
MBR-004716CLM-422482
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008791
Orphan claim re-pointed
Claims processor
CLM-426115 → UHC-98861-75 (Mateo Sims)
Member id
UHC-98861-75
Confidence
0.99
Method
probabilistic
MBR-002002CLM-426115
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008792
Orphan claim re-pointed
Claims processor
CLM-418881 → UHC-32019-99 (Anna Ward)
Member id
UHC-32019-99
Confidence
0.93
Method
probabilistic
MBR-013663CLM-418881
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008793
Orphan claim re-pointed
Claims processor
CLM-416376 → UHC-28975-92 (Timothy Aguilar)
Member id
UHC-28975-92
Confidence
0.97
Method
deterministic
MBR-021249CLM-416376
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008794
Orphan claim re-pointed
Claims processor
CLM-430394 → UHC-74719-65 (Douglas Phillips)
Member id
UHC-74719-65
Confidence
0.99
Method
probabilistic
MBR-018167CLM-430394
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008795
Orphan claim re-pointed
Claims processor
CLM-425880 → UHC-85627-10 (Robert Nichols)
Member id
UHC-85627-10
Confidence
0.93
Method
probabilistic
MBR-020281CLM-425880
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008796
Orphan claim re-pointed
Claims processor
CLM-420890 → UHC-50453-29 (Doris Bradley)
Member id
UHC-50453-29
Confidence
1
Method
probabilistic
MBR-022268CLM-420890
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008797
Orphan claim re-pointed
Claims processor
CLM-429924 → UHC-40496-41 (Stephen Freeman)
Member id
UHC-40496-41
Confidence
1
Method
probabilistic
MBR-007818CLM-429924
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008798
Orphan claim re-pointed
Claims processor
CLM-428039 → UHC-13090-50 (Daniel Vargas)
Member id
UHC-13090-50
Confidence
0.97
Method
deterministic
MBR-002672CLM-428039
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008799
Orphan claim re-pointed
Claims processor
CLM-413859 → UHC-52436-99 (Jose Adams)
Member id
UHC-52436-99
Confidence
1
Method
probabilistic
MBR-030009CLM-413859
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008800
Orphan claim re-pointed
Claims processor
CLM-429186 → UHC-85185-79 (Eric Williamson)
Member id
UHC-85185-79
Confidence
1
Method
probabilistic
MBR-010073CLM-429186
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008801
Orphan claim re-pointed
Claims processor
CLM-426163 → UHC-16125-24 (Albert Dominguez)
Member id
UHC-16125-24
Confidence
1
Method
probabilistic
MBR-023853CLM-426163
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008802
Orphan claim re-pointed
Claims processor
CLM-422947 → UHC-40645-66 (Betty Evans)
Member id
UHC-40645-66
Confidence
1
Method
probabilistic
MBR-011484CLM-422947
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008803
Orphan claim re-pointed
Claims processor
CLM-412220 → UHC-67757-69 (Ahmed Matthews)
Member id
UHC-67757-69
Confidence
0.97
Method
deterministic
MBR-001007CLM-412220
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008804
Orphan claim re-pointed
Claims processor
CLM-410811 → UHC-06257-82 (Nicole Richardson)
Member id
UHC-06257-82
Confidence
1
Method
probabilistic
MBR-001810CLM-410811
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008805
Orphan claim re-pointed
Claims processor
CLM-420632 → UHC-64545-68 (Beverly Pierce)
Member id
UHC-64545-68
Confidence
0.93
Method
probabilistic
MBR-025289CLM-420632
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008806
Orphan claim re-pointed
Claims processor
CLM-402584 → UHC-47581-55 (Lawrence Long)
Member id
UHC-47581-55
Confidence
1
Method
probabilistic
MBR-007150CLM-402584
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008807
Orphan claim re-pointed
Claims processor
CLM-429011 → UHC-43838-09 (Henry Hoffman)
Member id
UHC-43838-09
Confidence
0.97
Method
deterministic
MBR-034118CLM-429011
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008808
Orphan claim re-pointed
Claims processor
CLM-420455 → UHC-08987-22 (Janet Morales)
Member id
UHC-08987-22
Confidence
1
Method
probabilistic
MBR-004509CLM-420455
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008809
Orphan claim re-pointed
Claims processor
CLM-430747 → UHC-47320-20 (Sara Palmer)
Member id
UHC-47320-20
Confidence
0.97
Method
deterministic
MBR-007586CLM-430747
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008810
Orphan claim re-pointed
Claims processor
CLM-411042 → UHC-48330-57 (Douglas Cook)
Member id
UHC-48330-57
Confidence
0.97
Method
deterministic
MBR-030221CLM-411042
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008811
Orphan claim re-pointed
Claims processor
CLM-431689 → UHC-71794-17 (Jacqueline Richards)
Member id
UHC-71794-17
Confidence
1
Method
probabilistic
MBR-002078CLM-431689
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 314 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.