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-008862
Orphan claim re-pointed
Claims processor
CLM-425879 → UHC-17655-21 (Ethan Chavez)
Member id
UHC-17655-21
Confidence
1
Method
probabilistic
MBR-014869CLM-425879
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008863
Orphan claim re-pointed
Claims processor
CLM-417876 → UHC-17947-20 (Jessica Garza)
Member id
UHC-17947-20
Confidence
1
Method
probabilistic
MBR-025976CLM-417876
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008864
Orphan claim re-pointed
Claims processor
CLM-422659 → UHC-69799-61 (Melissa Dean)
Member id
UHC-69799-61
Confidence
1
Method
probabilistic
MBR-009071CLM-422659
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008865
Orphan claim re-pointed
Claims processor
CLM-401314 → UHC-98286-73 (Ahmed Schultz)
Member id
UHC-98286-73
Confidence
0.94
Method
probabilistic
MBR-004837CLM-401314
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008866
Orphan claim re-pointed
Claims processor
CLM-431897 → UHC-00300-86 (Melissa Medina)
Member id
UHC-00300-86
Confidence
0.97
Method
deterministic
MBR-004470CLM-431897
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008867
Orphan claim re-pointed
Claims processor
CLM-401801 → UHC-51799-64 (Kayla Lee)
Member id
UHC-51799-64
Confidence
1
Method
probabilistic
MBR-009866CLM-401801
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008868
Orphan claim re-pointed
Claims processor
CLM-405204 → UHC-75488-97 (Emma Smith)
Member id
UHC-75488-97
Confidence
1
Method
probabilistic
MBR-018278CLM-405204
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008869
Orphan claim re-pointed
Claims processor
CLM-431592 → UHC-28041-40 (Mary Hudson)
Member id
UHC-28041-40
Confidence
1
Method
probabilistic
MBR-005011CLM-431592
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008870
Orphan claim re-pointed
Claims processor
CLM-409138 → UHC-74963-28 (Bruce Adams)
Member id
UHC-74963-28
Confidence
0.97
Method
deterministic
MBR-016420CLM-409138
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008871
Orphan claim re-pointed
Claims processor
CLM-418405 → UHC-83336-39 (Deborah Vargas)
Member id
UHC-83336-39
Confidence
0.97
Method
deterministic
MBR-011491CLM-418405
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008872
Orphan claim re-pointed
Claims processor
CLM-423493 → UHC-35857-72 (Lauren Cooper)
Member id
UHC-35857-72
Confidence
1
Method
probabilistic
MBR-007216CLM-423493
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008873
Orphan claim re-pointed
Claims processor
CLM-429165 → UHC-70952-79 (Nathan Peters)
Member id
UHC-70952-79
Confidence
0.99
Method
probabilistic
MBR-003072CLM-429165
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008874
Orphan claim re-pointed
Claims processor
CLM-404755 → UHC-91703-40 (Jasoon Booyd)
Member id
UHC-91703-40
Confidence
0.97
Method
deterministic
MBR-025505CLM-404755
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008875
Orphan claim re-pointed
Claims processor
CLM-431426 → UHC-10708-39 (Lucia Foster)
Member id
UHC-10708-39
Confidence
0.92
Method
probabilistic
MBR-015501CLM-431426
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008876
Orphan claim re-pointed
Claims processor
CLM-415210 → UHC-11141-74 (Lucia Holmes)
Member id
UHC-11141-74
Confidence
1
Method
probabilistic
MBR-019290CLM-415210
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008877
Orphan claim re-pointed
Claims processor
CLM-431194 → UHC-73306-15 (Alexis Elliott)
Member id
UHC-73306-15
Confidence
1
Method
probabilistic
MBR-003622CLM-431194
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008878
Orphan claim re-pointed
Claims processor
CLM-421947 → UHC-15752-28 (Cheryl Murphy)
Member id
UHC-15752-28
Confidence
1
Method
probabilistic
MBR-023865CLM-421947
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008879
Orphan claim re-pointed
Claims processor
CLM-415059 → UHC-00530-80 (Diana Russell)
Member id
UHC-00530-80
Confidence
1
Method
probabilistic
MBR-028526CLM-415059
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008880
Orphan claim re-pointed
Claims processor
CLM-424335 → UHC-51207-32 (Wei Vazquez)
Member id
UHC-51207-32
Confidence
1
Method
probabilistic
MBR-018857CLM-424335
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008881
Orphan claim re-pointed
Claims processor
CLM-413820 → UHC-71548-92 (Nicholas Wells)
Member id
UHC-71548-92
Confidence
1
Method
probabilistic
MBR-030049CLM-413820
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008882
Orphan claim re-pointed
Claims processor
CLM-402904 → UHC-84406-53 (Alexander Contreras)
Member id
UHC-84406-53
Confidence
1
Method
probabilistic
MBR-002419CLM-402904
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008883
Orphan claim re-pointed
Claims processor
CLM-412292 → UHC-44106-88 (Virginia Ross)
Member id
UHC-44106-88
Confidence
0.97
Method
deterministic
MBR-020520CLM-412292
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008884
Orphan claim re-pointed
Claims processor
CLM-411332 → UHC-83800-64 (Sharon Hill)
Member id
UHC-83800-64
Confidence
1
Method
probabilistic
MBR-026571CLM-411332
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008885
Orphan claim re-pointed
Claims processor
CLM-405748 → UHC-92455-51 (Jacob Obrien)
Member id
UHC-92455-51
Confidence
0.98
Method
probabilistic
MBR-004420CLM-405748
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008886
Orphan claim re-pointed
Claims processor
CLM-419044 → UHC-95264-09 (Donald Reyes)
Member id
UHC-95264-09
Confidence
1
Method
probabilistic
MBR-013630CLM-419044
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008887
Orphan claim re-pointed
Claims processor
CLM-402258 → UHC-88172-45 (Lawrence Montgomery)
Member id
UHC-88172-45
Confidence
1
Method
probabilistic
MBR-007521CLM-402258
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008888
Orphan claim re-pointed
Claims processor
CLM-421191 → UHC-63850-64 (Sara Wood)
Member id
UHC-63850-64
Confidence
1
Method
probabilistic
MBR-015160CLM-421191
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008889
Orphan claim re-pointed
Claims processor
CLM-412009 → UHC-28458-04 (Gerald Jones)
Member id
UHC-28458-04
Confidence
0.99
Method
probabilistic
MBR-007936CLM-412009
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008890
Orphan claim re-pointed
Claims processor
CLM-426831 → UHC-12324-03 (Kathryn Payne)
Member id
UHC-12324-03
Confidence
1
Method
probabilistic
MBR-028845CLM-426831
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008891
Orphan claim re-pointed
Claims processor
CLM-416092 → UHC-94684-51 (Daniel Oliver)
Member id
UHC-94684-51
Confidence
1
Method
probabilistic
MBR-030465CLM-416092
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008892
Orphan claim re-pointed
Claims processor
CLM-400378 → UHC-39117-66 (Vicky Lynch)
Member id
UHC-39117-66
Confidence
0.87
Method
probabilistic
MBR-030704CLM-400378
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008893
Orphan claim re-pointed
Claims processor
CLM-410294 → UHC-42797-52 (Gabriel Padilla)
Member id
UHC-42797-52
Confidence
1
Method
probabilistic
MBR-040411CLM-410294
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008894
Orphan claim re-pointed
Claims processor
CLM-405205 → UHC-99813-04 (Brittany Campbell)
Member id
UHC-99813-04
Confidence
0.99
Method
probabilistic
MBR-015276CLM-405205
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008895
Orphan claim re-pointed
Claims processor
CLM-410339 → UHC-64318-81 (Rebecca Harris)
Member id
UHC-64318-81
Confidence
1
Method
probabilistic
MBR-007325CLM-410339
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008896
Orphan claim re-pointed
Claims processor
CLM-411589 → UHC-79519-71 (Heather Mendoza)
Member id
UHC-79519-71
Confidence
0.97
Method
deterministic
MBR-027372CLM-411589
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008897
Orphan claim re-pointed
Claims processor
CLM-404194 → UHC-39484-68 (Jason Green)
Member id
UHC-39484-68
Confidence
1
Method
probabilistic
MBR-002915CLM-404194
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008898
Orphan claim re-pointed
Claims processor
CLM-401175 → UHC-95934-32 (Emma Vasquez)
Member id
UHC-95934-32
Confidence
1
Method
probabilistic
MBR-023266CLM-401175
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008899
Orphan claim re-pointed
Claims processor
CLM-426804 → UHC-39743-86 (Hannah Chavez)
Member id
UHC-39743-86
Confidence
0.93
Method
probabilistic
MBR-018559CLM-426804
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008900
Orphan claim re-pointed
Claims processor
CLM-408854 → UHC-41752-65 (Martha Rogers)
Member id
UHC-41752-65
Confidence
1
Method
probabilistic
MBR-022671CLM-408854
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008901
Orphan claim re-pointed
Claims processor
CLM-405533 → UHC-59294-39 (Judith Riley)
Member id
UHC-59294-39
Confidence
1
Method
probabilistic
MBR-043332CLM-405533
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008902
Orphan claim re-pointed
Claims processor
CLM-411621 → UHC-88620-39 (Brandon Park)
Member id
UHC-88620-39
Confidence
1
Method
probabilistic
MBR-025220CLM-411621
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008903
Orphan claim re-pointed
Claims processor
CLM-420017 → UHC-19952-85 (Santiago Jimenez)
Member id
UHC-19952-85
Confidence
0.97
Method
deterministic
MBR-004929CLM-420017
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008904
Orphan claim re-pointed
Claims processor
CLM-409905 → UHC-88592-44 (Amber Howell)
Member id
UHC-88592-44
Confidence
1
Method
probabilistic
MBR-013614CLM-409905
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008905
Orphan claim re-pointed
Claims processor
CLM-429936 → UHC-24155-05 (Walter Flores)
Member id
UHC-24155-05
Confidence
1
Method
probabilistic
MBR-012400CLM-429936
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008906
Orphan claim re-pointed
Claims processor
CLM-426145 → UHC-78735-87 (Diana Mills)
Member id
UHC-78735-87
Confidence
1
Method
probabilistic
MBR-033154CLM-426145
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008907
Orphan claim re-pointed
Claims processor
CLM-413768 → UHC-95142-63 (Judy Green)
Member id
UHC-95142-63
Confidence
1
Method
probabilistic
MBR-026820CLM-413768
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008908
Orphan claim re-pointed
Claims processor
CLM-431875 → UHC-18805-90 (Patricia Rice)
Member id
UHC-18805-90
Confidence
0.97
Method
deterministic
MBR-032518CLM-431875
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008909
Orphan claim re-pointed
Claims processor
CLM-418587 → UHC-53202-94 (Debra Ortega)
Member id
UHC-53202-94
Confidence
1
Method
probabilistic
MBR-026252CLM-418587
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008910
Orphan claim re-pointed
Claims processor
CLM-425941 → UHC-85599-20 (Ralph Andrews)
Member id
UHC-85599-20
Confidence
1
Method
probabilistic
MBR-001382CLM-425941
Executed
resolution_agent
2026-10-22 12:47:23
ACT-008911
Orphan claim re-pointed
Claims processor
CLM-401656 → UHC-68627-66 (Albert Salazar)
Member id
UHC-68627-66
Confidence
0.93
Method
probabilistic
MBR-011721CLM-401656
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 316 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.