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-003340
Orphan claim re-pointed
Claims processor
CLM-405372 → UHC-30911-04 (Jennifer Berry)
Member id
UHC-30911-04
Confidence
0.85
Method
probabilistic
MBR-013032CLM-405372
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003341
Orphan claim re-pointed
Claims processor
CLM-403844 → UHC-50312-75 (Kimberly Cruz)
Member id
UHC-50312-75
Confidence
1
Method
probabilistic
MBR-004978CLM-403844
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003342
Orphan claim re-pointed
Claims processor
CLM-404231 → UHC-22060-18 (Ruth McDonald)
Member id
UHC-22060-18
Confidence
0.97
Method
deterministic
MBR-015285CLM-404231
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003343
Orphan claim re-pointed
Claims processor
CLM-427303 → UHC-88625-13 (Tyler Cole)
Member id
UHC-88625-13
Confidence
1
Method
probabilistic
MBR-012645CLM-427303
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003344
Orphan claim re-pointed
Claims processor
CLM-418100 → UHC-05763-13 (Denise Ortega)
Member id
UHC-05763-13
Confidence
1
Method
probabilistic
MBR-041447CLM-418100
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003345
Orphan claim re-pointed
Claims processor
CLM-407502 → UHC-86804-48 (Camila Sandoval)
Member id
UHC-86804-48
Confidence
0.93
Method
probabilistic
MBR-020178CLM-407502
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003346
Orphan claim re-pointed
Claims processor
CLM-427404 → UHC-55073-04 (Luis Leewis)
Member id
UHC-55073-04
Confidence
0.97
Method
deterministic
MBR-039496CLM-427404
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003347
Orphan claim re-pointed
Claims processor
CLM-413350 → UHC-16028-30 (Emma Mendez)
Member id
UHC-16028-30
Confidence
1
Method
probabilistic
MBR-036381CLM-413350
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003348
Orphan claim re-pointed
Claims processor
CLM-410898 → UHC-14493-37 (Cheryl Kennedy)
Member id
UHC-14493-37
Confidence
1
Method
probabilistic
MBR-022620CLM-410898
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003349
Orphan claim re-pointed
Claims processor
CLM-403915 → UHC-34464-25 (Arthur Guzman)
Member id
UHC-34464-25
Confidence
1
Method
probabilistic
MBR-016841CLM-403915
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003350
Orphan claim re-pointed
Claims processor
CLM-431784 → UHC-85105-06 (Michelle Le)
Member id
UHC-85105-06
Confidence
0.99
Method
probabilistic
MBR-033633CLM-431784
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003351
Orphan claim re-pointed
Claims processor
CLM-429638 → UHC-79488-43 (Ashley Brooks)
Member id
UHC-79488-43
Confidence
1
Method
probabilistic
MBR-006376CLM-429638
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003352
Orphan claim re-pointed
Claims processor
CLM-410209 → UHC-84878-58 (Sarah Edwards)
Member id
UHC-84878-58
Confidence
1
Method
probabilistic
MBR-021509CLM-410209
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003353
Orphan claim re-pointed
Claims processor
CLM-401846 → UHC-21471-68 (Ana Garcia)
Member id
UHC-21471-68
Confidence
1
Method
probabilistic
MBR-010880CLM-401846
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003354
Orphan claim re-pointed
Claims processor
CLM-410695 → UHC-77460-19 (Emily Anderson)
Member id
UHC-77460-19
Confidence
1
Method
probabilistic
MBR-001921CLM-410695
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003355
Orphan claim re-pointed
Claims processor
CLM-431993 → UHC-42321-42 (Sarah Long)
Member id
UHC-42321-42
Confidence
1
Method
probabilistic
MBR-012502CLM-431993
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003356
Orphan claim re-pointed
Claims processor
CLM-407351 → UHC-10303-10 (Nicholas Romero)
Member id
UHC-10303-10
Confidence
0.99
Method
probabilistic
MBR-022274CLM-407351
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003357
Orphan claim re-pointed
Claims processor
CLM-413984 → UHC-82124-92 (Rachel Smith)
Member id
UHC-82124-92
Confidence
1
Method
probabilistic
MBR-024195CLM-413984
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003358
Orphan claim re-pointed
Claims processor
CLM-425609 → UHC-84542-04 (Nicole Evans)
Member id
UHC-84542-04
Confidence
1
Method
probabilistic
MBR-033414CLM-425609
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003359
Orphan claim re-pointed
Claims processor
CLM-410789 → UHC-38202-11 (Deb McDonald)
Member id
UHC-38202-11
Confidence
1
Method
probabilistic
MBR-023928CLM-410789
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003360
Orphan claim re-pointed
Claims processor
CLM-416031 → UHC-87826-91 (Melissa Rodriguez)
Member id
UHC-87826-91
Confidence
1
Method
probabilistic
MBR-007318CLM-416031
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003361
Orphan claim re-pointed
Claims processor
CLM-418188 → UHC-96996-81 (Jennifer Powell)
Member id
UHC-96996-81
Confidence
1
Method
probabilistic
MBR-006519CLM-418188
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003362
Orphan claim re-pointed
Claims processor
CLM-423740 → UHC-32392-13 (Pmaela Berry)
Member id
UHC-32392-13
Confidence
0.99
Method
probabilistic
MBR-005785CLM-423740
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003363
Orphan claim re-pointed
Claims processor
CLM-411190 → UHC-33676-78 (Brandon Bennett)
Member id
UHC-33676-78
Confidence
0.99
Method
probabilistic
MBR-008565CLM-411190
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003364
Orphan claim re-pointed
Claims processor
CLM-412734 → UHC-44774-84 (Eugene Richardson)
Member id
UHC-44774-84
Confidence
1
Method
probabilistic
MBR-008997CLM-412734
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003365
Orphan claim re-pointed
Claims processor
CLM-407552 → UHC-56755-08 (Samantha Greene)
Member id
UHC-56755-08
Confidence
1
Method
probabilistic
MBR-037525CLM-407552
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003366
Orphan claim re-pointed
Claims processor
CLM-402602 → UHC-45508-66 (Thomas Cook)
Member id
UHC-45508-66
Confidence
1
Method
probabilistic
MBR-027413CLM-402602
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003367
Orphan claim re-pointed
Claims processor
CLM-422628 → UHC-25483-47 (Diane Simmons)
Member id
UHC-25483-47
Confidence
1
Method
probabilistic
MBR-041540CLM-422628
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003368
Orphan claim re-pointed
Claims processor
CLM-416621 → UHC-22905-01 (Wayne Bailey)
Member id
UHC-22905-01
Confidence
1
Method
probabilistic
MBR-003535CLM-416621
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003369
Orphan claim re-pointed
Claims processor
CLM-409971 → UHC-84539-43 (Dylan Foster)
Member id
UHC-84539-43
Confidence
1
Method
probabilistic
MBR-018096CLM-409971
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003370
Orphan claim re-pointed
Claims processor
CLM-425866 → UHC-28110-84 (Roger Gordon)
Member id
UHC-28110-84
Confidence
0.99
Method
probabilistic
MBR-011208CLM-425866
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003371
Orphan claim re-pointed
Claims processor
CLM-425605 → UHC-75343-29 (Lauren Wang)
Member id
UHC-75343-29
Confidence
1
Method
probabilistic
MBR-000146CLM-425605
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003372
Orphan claim re-pointed
Claims processor
CLM-404383 → UHC-06599-74 (Arthur Meyer)
Member id
UHC-06599-74
Confidence
1
Method
probabilistic
MBR-011200CLM-404383
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003373
Orphan claim re-pointed
Claims processor
CLM-404559 → UHC-45682-55 (David Daniels)
Member id
UHC-45682-55
Confidence
1
Method
probabilistic
MBR-003333CLM-404559
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003374
Orphan claim re-pointed
Claims processor
CLM-409901 → UHC-39979-07 (Scott Hart)
Member id
UHC-39979-07
Confidence
1
Method
probabilistic
MBR-001199CLM-409901
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003375
Orphan claim re-pointed
Claims processor
CLM-403359 → UHC-56158-59 (Jose Dixon)
Member id
UHC-56158-59
Confidence
0.97
Method
deterministic
MBR-035601CLM-403359
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003376
Orphan claim re-pointed
Claims processor
CLM-413689 → UHC-35596-29 (Anthony Palmer)
Member id
UHC-35596-29
Confidence
1
Method
probabilistic
MBR-024296CLM-413689
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003377
Orphan claim re-pointed
Claims processor
CLM-403323 → UHC-76050-53 (Luis Lucas)
Member id
UHC-76050-53
Confidence
0.99
Method
probabilistic
MBR-004247CLM-403323
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003378
Orphan claim re-pointed
Claims processor
CLM-402259 → UHC-45753-10 (Andrea Gonzles)
Member id
UHC-45753-10
Confidence
1.00
Method
probabilistic
MBR-022375CLM-402259
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003379
Orphan claim re-pointed
Claims processor
CLM-428042 → UHC-34443-43 (Austin Santos)
Member id
UHC-34443-43
Confidence
1
Method
probabilistic
MBR-002733CLM-428042
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003380
Orphan claim re-pointed
Claims processor
CLM-431039 → UHC-04560-91 (Madison Ortega)
Member id
UHC-04560-91
Confidence
0.86
Method
probabilistic
MBR-040368CLM-431039
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003381
Orphan claim re-pointed
Claims processor
CLM-417186 → UHC-87854-09 (Julia Jackson)
Member id
UHC-87854-09
Confidence
1
Method
probabilistic
MBR-009925CLM-417186
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003382
Orphan claim re-pointed
Claims processor
CLM-430816 → UHC-56570-23 (Diego Montgomery)
Member id
UHC-56570-23
Confidence
1
Method
probabilistic
MBR-002410CLM-430816
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003383
Orphan claim re-pointed
Claims processor
CLM-425254 → UHC-36645-75 (Sophia Hunt)
Member id
UHC-36645-75
Confidence
1
Method
probabilistic
MBR-005512CLM-425254
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003384
Orphan claim re-pointed
Claims processor
CLM-407307 → UHC-77213-11 (Rachel Watson)
Member id
UHC-77213-11
Confidence
1
Method
probabilistic
MBR-019966CLM-407307
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003385
Orphan claim re-pointed
Claims processor
CLM-418220 → UHC-37752-51 (Stephen Brown)
Member id
UHC-37752-51
Confidence
1
Method
probabilistic
MBR-019443CLM-418220
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003386
Orphan claim re-pointed
Claims processor
CLM-426778 → UHC-97344-04 (Roy Ellis)
Member id
UHC-97344-04
Confidence
0.99
Method
probabilistic
MBR-006427CLM-426778
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003387
Orphan claim re-pointed
Claims processor
CLM-412063 → UHC-76772-44 (Bradley Armstrong)
Member id
UHC-76772-44
Confidence
0.89
Method
probabilistic
MBR-010209CLM-412063
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003388
Orphan claim re-pointed
Claims processor
CLM-426520 → UHC-76289-79 (Kelly Robinson)
Member id
UHC-76289-79
Confidence
0.97
Method
deterministic
MBR-021425CLM-426520
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003389
Orphan claim re-pointed
Claims processor
CLM-406267 → UHC-11986-50 (Justin Moore)
Member id
UHC-11986-50
Confidence
1
Method
probabilistic
MBR-019840CLM-406267
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 41 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.