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-002890
Orphan claim re-pointed
Claims processor
CLM-401249 → UHC-58390-13 (Lisa Hawkins)
Member id
UHC-58390-13
Confidence
0.97
Method
deterministic
MBR-028273CLM-401249
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002891
Orphan claim re-pointed
Claims processor
CLM-421971 → UHC-89812-55 (Jonathan Bowman)
Member id
UHC-89812-55
Confidence
0.97
Method
deterministic
MBR-006544CLM-421971
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002892
Orphan claim re-pointed
Claims processor
CLM-414452 → UHC-13952-38 (Yuki Wood)
Member id
UHC-13952-38
Confidence
1
Method
probabilistic
MBR-011081CLM-414452
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002893
Orphan claim re-pointed
Claims processor
CLM-430943 → UHC-64949-34 (Michelle Bowman)
Member id
UHC-64949-34
Confidence
1
Method
probabilistic
MBR-013784CLM-430943
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002894
Orphan claim re-pointed
Claims processor
CLM-427160 → UHC-37768-97 (Susan Owens)
Member id
UHC-37768-97
Confidence
0.97
Method
deterministic
MBR-020974CLM-427160
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002895
Orphan claim re-pointed
Claims processor
CLM-401794 → UHC-29142-83 (Grace James)
Member id
UHC-29142-83
Confidence
1
Method
probabilistic
MBR-014730CLM-401794
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002896
Orphan claim re-pointed
Claims processor
CLM-407517 → UHC-97544-20 (Lawrence Maldonado)
Member id
UHC-97544-20
Confidence
1
Method
probabilistic
MBR-000899CLM-407517
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002897
Orphan claim re-pointed
Claims processor
CLM-412349 → UHC-13186-78 (Valentina Daniels)
Member id
UHC-13186-78
Confidence
0.97
Method
deterministic
MBR-003344CLM-412349
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002898
Orphan claim re-pointed
Claims processor
CLM-412414 → UHC-54412-91 (Harold Smith)
Member id
UHC-54412-91
Confidence
1
Method
probabilistic
MBR-022789CLM-412414
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002899
Orphan claim re-pointed
Claims processor
CLM-432190 → UHC-18952-16 (Doris Obrien)
Member id
UHC-18952-16
Confidence
0.93
Method
probabilistic
MBR-018628CLM-432190
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002900
Orphan claim re-pointed
Claims processor
CLM-421190 → UHC-89616-14 (Brian Fuller)
Member id
UHC-89616-14
Confidence
0.93
Method
probabilistic
MBR-010687CLM-421190
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002901
Orphan claim re-pointed
Claims processor
CLM-426719 → UHC-58954-01 (Barbara Hicks)
Member id
UHC-58954-01
Confidence
1
Method
probabilistic
MBR-032711CLM-426719
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002902
Orphan claim re-pointed
Claims processor
CLM-411097 → UHC-90440-20 (Roger Robertson)
Member id
UHC-90440-20
Confidence
1
Method
probabilistic
MBR-017483CLM-411097
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002903
Orphan claim re-pointed
Claims processor
CLM-404163 → UHC-97762-04 (Emily Rojas)
Member id
UHC-97762-04
Confidence
0.97
Method
deterministic
MBR-013577CLM-404163
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002904
Orphan claim re-pointed
Claims processor
CLM-417095 → UHC-61639-29 (Ashley Olson)
Member id
UHC-61639-29
Confidence
0.97
Method
deterministic
MBR-036818CLM-417095
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002905
Orphan claim re-pointed
Claims processor
CLM-402547 → UHC-75180-73 (Katherine Martin)
Member id
UHC-75180-73
Confidence
0.97
Method
deterministic
MBR-018191CLM-402547
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002906
Orphan claim re-pointed
Claims processor
CLM-403195 → UHC-89275-42 (Dennis Hunt)
Member id
UHC-89275-42
Confidence
1
Method
probabilistic
MBR-033966CLM-403195
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002907
Orphan claim re-pointed
Claims processor
CLM-405747 → UHC-27611-32 (Virginia Grant)
Member id
UHC-27611-32
Confidence
1
Method
probabilistic
MBR-035415CLM-405747
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002908
Orphan claim re-pointed
Claims processor
CLM-429405 → UHC-79908-24 (Edward Edwards)
Member id
UHC-79908-24
Confidence
1
Method
probabilistic
MBR-025267CLM-429405
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002909
Orphan claim re-pointed
Claims processor
CLM-427849 → UHC-64161-60 (Sean Mason)
Member id
UHC-64161-60
Confidence
1
Method
probabilistic
MBR-003438CLM-427849
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002910
Orphan claim re-pointed
Claims processor
CLM-423049 → UHC-50559-22 (Alan Adams)
Member id
UHC-50559-22
Confidence
1
Method
probabilistic
MBR-022219CLM-423049
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002911
Orphan claim re-pointed
Claims processor
CLM-408620 → UHC-33957-43 (Kyle Vega)
Member id
UHC-33957-43
Confidence
1
Method
probabilistic
MBR-011634CLM-408620
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002912
Orphan claim re-pointed
Claims processor
CLM-427924 → UHC-21648-41 (Marcus Clark)
Member id
UHC-21648-41
Confidence
0.99
Method
probabilistic
MBR-010772CLM-427924
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002913
Orphan claim re-pointed
Claims processor
CLM-429845 → UHC-24431-19 (Diane Howell)
Member id
UHC-24431-19
Confidence
0.98
Method
probabilistic
MBR-043671CLM-429845
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002914
Orphan claim re-pointed
Claims processor
CLM-418916 → UHC-04083-81 (Natalie Yang)
Member id
UHC-04083-81
Confidence
1
Method
probabilistic
MBR-028100CLM-418916
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002915
Orphan claim re-pointed
Claims processor
CLM-402012 → UHC-30565-43 (Natalie Morgan)
Member id
UHC-30565-43
Confidence
1
Method
probabilistic
MBR-017156CLM-402012
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002916
Orphan claim re-pointed
Claims processor
CLM-413846 → UHC-02340-97 (Mei Lee)
Member id
UHC-02340-97
Confidence
1
Method
probabilistic
MBR-010235CLM-413846
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002917
Orphan claim re-pointed
Claims processor
CLM-400943 → UHC-76429-95 (Amber Walker)
Member id
UHC-76429-95
Confidence
1
Method
probabilistic
MBR-038473CLM-400943
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002918
Orphan claim re-pointed
Claims processor
CLM-412343 → UHC-19218-47 (Katherine Carter)
Member id
UHC-19218-47
Confidence
0.97
Method
deterministic
MBR-011815CLM-412343
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002919
Orphan claim re-pointed
Claims processor
CLM-413593 → UHC-13835-02 (Mark Arnold)
Member id
UHC-13835-02
Confidence
0.93
Method
probabilistic
MBR-034505CLM-413593
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002920
Orphan claim re-pointed
Claims processor
CLM-422019 → UHC-66524-42 (Cynthia Kelley)
Member id
UHC-66524-42
Confidence
0.94
Method
probabilistic
MBR-018413CLM-422019
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002921
Orphan claim re-pointed
Claims processor
CLM-425923 → UHC-94421-04 (Megan Allen)
Member id
UHC-94421-04
Confidence
1
Method
probabilistic
MBR-004533CLM-425923
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002922
Orphan claim re-pointed
Claims processor
CLM-421606 → UHC-29310-40 (Joe Lucas)
Member id
UHC-29310-40
Confidence
0.97
Method
deterministic
MBR-004544CLM-421606
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002923
Orphan claim re-pointed
Claims processor
CLM-401100 → UHC-51567-53 (Martha Padilla)
Member id
UHC-51567-53
Confidence
1
Method
probabilistic
MBR-003529CLM-401100
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002924
Orphan claim re-pointed
Claims processor
CLM-417977 → UHC-48459-62 (Hiroshi Park)
Member id
UHC-48459-62
Confidence
0.98
Method
probabilistic
MBR-005338CLM-417977
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002925
Orphan claim re-pointed
Claims processor
CLM-426577 → UHC-28952-82 (Ralph Kelley)
Member id
UHC-28952-82
Confidence
0.97
Method
deterministic
MBR-009663CLM-426577
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002926
Orphan claim re-pointed
Claims processor
CLM-421547 → UHC-89061-19 (Nathan Martinez)
Member id
UHC-89061-19
Confidence
1
Method
probabilistic
MBR-009420CLM-421547
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002927
Orphan claim re-pointed
Claims processor
CLM-416144 → UHC-00245-28 (Bryan Evans)
Member id
UHC-00245-28
Confidence
1
Method
probabilistic
MBR-029400CLM-416144
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002928
Orphan claim re-pointed
Claims processor
CLM-405290 → UHC-97566-56 (Catherine Myers)
Member id
UHC-97566-56
Confidence
0.99
Method
probabilistic
MBR-008124CLM-405290
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002929
Orphan claim re-pointed
Claims processor
CLM-416559 → UHC-69037-54 (Jack Bowman)
Member id
UHC-69037-54
Confidence
0.97
Method
deterministic
MBR-021077CLM-416559
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002930
Orphan claim re-pointed
Claims processor
CLM-428512 → UHC-54516-18 (Hannah Nelson)
Member id
UHC-54516-18
Confidence
1
Method
probabilistic
MBR-002099CLM-428512
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002931
Orphan claim re-pointed
Claims processor
CLM-406666 → UHC-90741-18 (Randy Lawrence)
Member id
UHC-90741-18
Confidence
1
Method
probabilistic
MBR-020995CLM-406666
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002932
Orphan claim re-pointed
Claims processor
CLM-407292 → UHC-65197-96 (Joyce Thompson)
Member id
UHC-65197-96
Confidence
0.93
Method
probabilistic
MBR-042049CLM-407292
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002933
Orphan claim re-pointed
Claims processor
CLM-427424 → UHC-83773-63 (Eric Russell)
Member id
UHC-83773-63
Confidence
1
Method
probabilistic
MBR-034445CLM-427424
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002934
Orphan claim re-pointed
Claims processor
CLM-421119 → UHC-85610-69 (Evelyn Maldonado)
Member id
UHC-85610-69
Confidence
1
Method
probabilistic
MBR-021644CLM-421119
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002935
Orphan claim re-pointed
Claims processor
CLM-419744 → UHC-31513-50 (Sophia Myers)
Member id
UHC-31513-50
Confidence
1
Method
probabilistic
MBR-022127CLM-419744
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002936
Orphan claim re-pointed
Claims processor
CLM-419553 → UHC-28348-73 (Gerald Fisher)
Member id
UHC-28348-73
Confidence
0.93
Method
probabilistic
MBR-039258CLM-419553
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002937
Orphan claim re-pointed
Claims processor
CLM-423377 → UHC-34873-65 (Jacob Cruz)
Member id
UHC-34873-65
Confidence
1
Method
probabilistic
MBR-019783CLM-423377
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002938
Orphan claim re-pointed
Claims processor
CLM-432355 → UHC-34803-46 (Mariana Morrison)
Member id
UHC-34803-46
Confidence
0.97
Method
deterministic
MBR-016992CLM-432355
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002939
Orphan claim re-pointed
Claims processor
CLM-417437 → UHC-92117-15 (Angela Sullivan)
Member id
UHC-92117-15
Confidence
1
Method
probabilistic
MBR-005196CLM-417437
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 32 of 282PreviousNext

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.