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-003190
Orphan claim re-pointed
Claims processor
CLM-413415 → UHC-03506-53 (Bobby Miller)
Member id
UHC-03506-53
Confidence
1
Method
probabilistic
MBR-021075CLM-413415
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003191
Orphan claim re-pointed
Claims processor
CLM-404189 → UHC-96450-94 (Ryan Mendez)
Member id
UHC-96450-94
Confidence
1
Method
probabilistic
MBR-034546CLM-404189
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003192
Orphan claim re-pointed
Claims processor
CLM-406092 → UHC-24038-47 (Kayla Myers)
Member id
UHC-24038-47
Confidence
1
Method
probabilistic
MBR-013257CLM-406092
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003193
Orphan claim re-pointed
Claims processor
CLM-427272 → UHC-46810-51 (Andrea Valdez)
Member id
UHC-46810-51
Confidence
1
Method
probabilistic
MBR-029604CLM-427272
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003194
Orphan claim re-pointed
Claims processor
CLM-401027 → UHC-89960-59 (Maria Long)
Member id
UHC-89960-59
Confidence
0.87
Method
probabilistic
MBR-022067CLM-401027
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003195
Orphan claim re-pointed
Claims processor
CLM-406042 → UHC-91522-50 (Barbara Black)
Member id
UHC-91522-50
Confidence
0.97
Method
deterministic
MBR-004417CLM-406042
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003196
Orphan claim re-pointed
Claims processor
CLM-425891 → UHC-90277-38 (Randy Edwards)
Member id
UHC-90277-38
Confidence
1
Method
probabilistic
MBR-013522CLM-425891
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003197
Orphan claim re-pointed
Claims processor
CLM-425066 → UHC-92098-20 (Danielle Henry)
Member id
UHC-92098-20
Confidence
0.93
Method
probabilistic
MBR-015401CLM-425066
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003198
Orphan claim re-pointed
Claims processor
CLM-425491 → UHC-29134-81 (Kathleen Jordan)
Member id
UHC-29134-81
Confidence
1
Method
probabilistic
MBR-005329CLM-425491
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003199
Orphan claim re-pointed
Claims processor
CLM-423192 → UHC-11466-95 (Nicholas Jenkins)
Member id
UHC-11466-95
Confidence
0.97
Method
deterministic
MBR-022352CLM-423192
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003200
Orphan claim re-pointed
Claims processor
CLM-412376 → UHC-44193-52 (Mei Lee)
Member id
UHC-44193-52
Confidence
0.97
Method
deterministic
MBR-006820CLM-412376
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003201
Orphan claim re-pointed
Claims processor
CLM-415255 → UHC-16904-99 (Ralph Pena)
Member id
UHC-16904-99
Confidence
1
Method
probabilistic
MBR-031031CLM-415255
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003202
Orphan claim re-pointed
Claims processor
CLM-429176 → UHC-68765-49 (Virginia Ramos)
Member id
UHC-68765-49
Confidence
1
Method
probabilistic
MBR-034474CLM-429176
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003203
Orphan claim re-pointed
Claims processor
CLM-431250 → UHC-93560-89 (Barbara Cox)
Member id
UHC-93560-89
Confidence
0.97
Method
deterministic
MBR-010121CLM-431250
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003204
Orphan claim re-pointed
Claims processor
CLM-412960 → UHC-14875-55 (Scott Jordan)
Member id
UHC-14875-55
Confidence
0.97
Method
deterministic
MBR-019021CLM-412960
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003205
Orphan claim re-pointed
Claims processor
CLM-430934 → UHC-56499-04 (Deborah Hughes)
Member id
UHC-56499-04
Confidence
1
Method
probabilistic
MBR-023416CLM-430934
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003206
Orphan claim re-pointed
Claims processor
CLM-428161 → UHC-30097-39 (Shirley Vasquez)
Member id
UHC-30097-39
Confidence
1
Method
probabilistic
MBR-016792CLM-428161
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003207
Orphan claim re-pointed
Claims processor
CLM-401862 → UHC-27010-24 (Emily Warren)
Member id
UHC-27010-24
Confidence
0.99
Method
probabilistic
MBR-002846CLM-401862
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003208
Orphan claim re-pointed
Claims processor
CLM-422638 → UHC-31727-18 (Patricia Green)
Member id
UHC-31727-18
Confidence
0.97
Method
deterministic
MBR-039801CLM-422638
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003209
Orphan claim re-pointed
Claims processor
CLM-428381 → UHC-18632-72 (Juan Marshall)
Member id
UHC-18632-72
Confidence
0.97
Method
deterministic
MBR-024283CLM-428381
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003210
Orphan claim re-pointed
Claims processor
CLM-411119 → UHC-87523-88 (Jessica Evans)
Member id
UHC-87523-88
Confidence
1.00
Method
probabilistic
MBR-021197CLM-411119
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003211
Orphan claim re-pointed
Claims processor
CLM-414796 → UHC-99785-70 (Julia Weber)
Member id
UHC-99785-70
Confidence
1
Method
probabilistic
MBR-015757CLM-414796
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003212
Orphan claim re-pointed
Claims processor
CLM-418616 → UHC-03397-06 (Natalie Ramos)
Member id
UHC-03397-06
Confidence
1
Method
probabilistic
MBR-011548CLM-418616
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003213
Orphan claim re-pointed
Claims processor
CLM-408713 → UHC-60268-18 (Carlos Li)
Member id
UHC-60268-18
Confidence
1
Method
probabilistic
MBR-005851CLM-408713
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003214
Orphan claim re-pointed
Claims processor
CLM-421945 → UHC-13221-79 (Harold Green)
Member id
UHC-13221-79
Confidence
0.97
Method
deterministic
MBR-024016CLM-421945
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003215
Orphan claim re-pointed
Claims processor
CLM-419019 → UHC-10886-62 (Josua Taylor)
Member id
UHC-10886-62
Confidence
0.99
Method
probabilistic
MBR-030923CLM-419019
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003216
Orphan claim re-pointed
Claims processor
CLM-428945 → UHC-97391-25 (Pamela Baker)
Member id
UHC-97391-25
Confidence
1
Method
probabilistic
MBR-018016CLM-428945
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003217
Orphan claim re-pointed
Claims processor
CLM-423650 → UHC-56594-06 (Mason Vasquez)
Member id
UHC-56594-06
Confidence
1
Method
probabilistic
MBR-002129CLM-423650
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003218
Orphan claim re-pointed
Claims processor
CLM-432506 → UHC-50103-28 (Laura Torres)
Member id
UHC-50103-28
Confidence
1
Method
probabilistic
MBR-023402CLM-432506
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003219
Orphan claim re-pointed
Claims processor
CLM-414153 → UHC-21155-12 (Benjamin Moore)
Member id
UHC-21155-12
Confidence
0.99
Method
probabilistic
MBR-014314CLM-414153
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003220
Orphan claim re-pointed
Claims processor
CLM-416086 → UHC-71965-17 (Arjun Harris)
Member id
UHC-71965-17
Confidence
1
Method
probabilistic
MBR-005433CLM-416086
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003221
Orphan claim re-pointed
Claims processor
CLM-412495 → UHC-69888-49 (Cynthia Watkins)
Member id
UHC-69888-49
Confidence
1
Method
probabilistic
MBR-028933CLM-412495
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003222
Orphan claim re-pointed
Claims processor
CLM-421441 → UHC-72044-34 (Victoria Rogers)
Member id
UHC-72044-34
Confidence
0.97
Method
deterministic
MBR-045286CLM-421441
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003223
Orphan claim re-pointed
Claims processor
CLM-415244 → UHC-34996-49 (Ann Gonzalez)
Member id
UHC-34996-49
Confidence
1
Method
probabilistic
MBR-023972CLM-415244
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003224
Orphan claim re-pointed
Claims processor
CLM-418350 → UHC-16280-18 (Stephen Robertson)
Member id
UHC-16280-18
Confidence
0.97
Method
deterministic
MBR-021784CLM-418350
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003225
Orphan claim re-pointed
Claims processor
CLM-413267 → UHC-97917-42 (Katherine Gomez)
Member id
UHC-97917-42
Confidence
1
Method
probabilistic
MBR-020037CLM-413267
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003226
Orphan claim re-pointed
Claims processor
CLM-430148 → UHC-37114-42 (Mariana Lee)
Member id
UHC-37114-42
Confidence
1
Method
probabilistic
MBR-035472CLM-430148
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003227
Orphan claim re-pointed
Claims processor
CLM-412596 → UHC-43169-47 (Kathleen Brown)
Member id
UHC-43169-47
Confidence
0.93
Method
probabilistic
MBR-017740CLM-412596
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003228
Orphan claim re-pointed
Claims processor
CLM-427545 → UHC-33142-39 (Joe Hicks)
Member id
UHC-33142-39
Confidence
1
Method
probabilistic
MBR-002840CLM-427545
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003229
Orphan claim re-pointed
Claims processor
CLM-418594 → UHC-97802-47 (Jessica Adams)
Member id
UHC-97802-47
Confidence
1
Method
probabilistic
MBR-009046CLM-418594
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003230
Orphan claim re-pointed
Claims processor
CLM-430950 → UHC-06199-48 (Timothy Robinson)
Member id
UHC-06199-48
Confidence
0.97
Method
deterministic
MBR-033199CLM-430950
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003231
Orphan claim re-pointed
Claims processor
CLM-408301 → UHC-60955-24 (Michelle Jensen)
Member id
UHC-60955-24
Confidence
1
Method
probabilistic
MBR-016856CLM-408301
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003232
Orphan claim re-pointed
Claims processor
CLM-408128 → UHC-76335-04 (Christian Romero)
Member id
UHC-76335-04
Confidence
1
Method
probabilistic
MBR-033374CLM-408128
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003233
Orphan claim re-pointed
Claims processor
CLM-401040 → UHC-21428-38 (Denise Riley)
Member id
UHC-21428-38
Confidence
1
Method
probabilistic
MBR-038775CLM-401040
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003234
Orphan claim re-pointed
Claims processor
CLM-432517 → UHC-44059-85 (Isabella Gordon)
Member id
UHC-44059-85
Confidence
1.00
Method
probabilistic
MBR-006894CLM-432517
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003235
Orphan claim re-pointed
Claims processor
CLM-408849 → UHC-25369-28 (Mariana Mason)
Member id
UHC-25369-28
Confidence
1
Method
probabilistic
MBR-002101CLM-408849
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003236
Orphan claim re-pointed
Claims processor
CLM-427292 → UHC-01570-93 (Theresa King)
Member id
UHC-01570-93
Confidence
1
Method
probabilistic
MBR-022848CLM-427292
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003237
Orphan claim re-pointed
Claims processor
CLM-426753 → UHC-85125-76 (Raymond Vargas)
Member id
UHC-85125-76
Confidence
0.97
Method
deterministic
MBR-006310CLM-426753
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003238
Orphan claim re-pointed
Claims processor
CLM-426185 → UHC-68036-12 (Alexander Chavez)
Member id
UHC-68036-12
Confidence
1
Method
probabilistic
MBR-005017CLM-426185
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003239
Orphan claim re-pointed
Claims processor
CLM-410304 → UHC-58060-51 (Emma Wagner)
Member id
UHC-58060-51
Confidence
0.97
Method
deterministic
MBR-026340CLM-410304
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 38 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.