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-003390
Orphan claim re-pointed
Claims processor
CLM-406450 → UHC-21684-62 (Sophia Marquez)
Member id
UHC-21684-62
Confidence
1
Method
probabilistic
MBR-007718CLM-406450
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003391
Orphan claim re-pointed
Claims processor
CLM-402371 → UHC-45752-49 (Debra Ray)
Member id
UHC-45752-49
Confidence
1
Method
probabilistic
MBR-011675CLM-402371
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003392
Orphan claim re-pointed
Claims processor
CLM-400897 → UHC-83341-11 (Olivia Olivia)
Member id
UHC-83341-11
Confidence
0.99
Method
probabilistic
MBR-012528CLM-400897
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003393
Orphan claim re-pointed
Claims processor
CLM-423904 → UHC-75138-92 (Camila Bennett)
Member id
UHC-75138-92
Confidence
0.99
Method
probabilistic
MBR-030513CLM-423904
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003394
Orphan claim re-pointed
Claims processor
CLM-409965 → UHC-08632-94 (Henry Espinoza)
Member id
UHC-08632-94
Confidence
1
Method
probabilistic
MBR-014561CLM-409965
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003395
Orphan claim re-pointed
Claims processor
CLM-415848 → UHC-89742-06 (Camila Marshall)
Member id
UHC-89742-06
Confidence
1
Method
probabilistic
MBR-002727CLM-415848
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003396
Orphan claim re-pointed
Claims processor
CLM-406942 → UHC-39071-71 (Natalie Riley)
Member id
UHC-39071-71
Confidence
0.97
Method
deterministic
MBR-003320CLM-406942
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003397
Orphan claim re-pointed
Claims processor
CLM-421936 → UHC-62961-20 (Wei Fields)
Member id
UHC-62961-20
Confidence
1
Method
probabilistic
MBR-012283CLM-421936
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003398
Orphan claim re-pointed
Claims processor
CLM-407791 → UHC-46045-09 (Jonathan Maldonado)
Member id
UHC-46045-09
Confidence
1
Method
probabilistic
MBR-008097CLM-407791
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003399
Orphan claim re-pointed
Claims processor
CLM-423728 → UHC-28983-41 (Grace Hicks)
Member id
UHC-28983-41
Confidence
1
Method
probabilistic
MBR-043312CLM-423728
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003400
Orphan claim re-pointed
Claims processor
CLM-403718 → UHC-33098-14 (Matthew Snyder)
Member id
UHC-33098-14
Confidence
1.00
Method
probabilistic
MBR-018580CLM-403718
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003401
Orphan claim re-pointed
Claims processor
CLM-400385 → UHC-25857-44 (Alice Hall)
Member id
UHC-25857-44
Confidence
1
Method
probabilistic
MBR-027070CLM-400385
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003402
Orphan claim re-pointed
Claims processor
CLM-426488 → UHC-22092-71 (Seen Jones)
Member id
UHC-22092-71
Confidence
0.97
Method
deterministic
MBR-003377CLM-426488
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003403
Orphan claim re-pointed
Claims processor
CLM-432412 → UHC-61460-03 (Judy Henry)
Member id
UHC-61460-03
Confidence
1
Method
probabilistic
MBR-004026CLM-432412
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003404
Orphan claim re-pointed
Claims processor
CLM-416981 → UHC-19530-96 (Sarah Banks)
Member id
UHC-19530-96
Confidence
1
Method
probabilistic
MBR-010468CLM-416981
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003405
Orphan claim re-pointed
Claims processor
CLM-406260 → UHC-01980-86 (Sophia Lynch)
Member id
UHC-01980-86
Confidence
1
Method
probabilistic
MBR-008897CLM-406260
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003406
Orphan claim re-pointed
Claims processor
CLM-405352 → UHC-96725-82 (Santiago Gardner)
Member id
UHC-96725-82
Confidence
0.93
Method
probabilistic
MBR-029552CLM-405352
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003407
Orphan claim re-pointed
Claims processor
CLM-417965 → UHC-92206-23 (Sofia Ramirez)
Member id
UHC-92206-23
Confidence
0.94
Method
probabilistic
MBR-023835CLM-417965
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003408
Orphan claim re-pointed
Claims processor
CLM-403296 → UHC-48999-54 (Billy Robinson)
Member id
UHC-48999-54
Confidence
1
Method
probabilistic
MBR-000801CLM-403296
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003409
Orphan claim re-pointed
Claims processor
CLM-419309 → UHC-92686-75 (Rebecca Munoz)
Member id
UHC-92686-75
Confidence
1
Method
probabilistic
MBR-012726CLM-419309
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003410
Orphan claim re-pointed
Claims processor
CLM-412448 → UHC-47662-48 (Kevin Lewis)
Member id
UHC-47662-48
Confidence
1
Method
probabilistic
MBR-024802CLM-412448
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003411
Orphan claim re-pointed
Claims processor
CLM-401110 → UHC-76166-29 (Timothy Hernandez)
Member id
UHC-76166-29
Confidence
0.97
Method
probabilistic
MBR-002028CLM-401110
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003412
Orphan claim re-pointed
Claims processor
CLM-423872 → UHC-59566-95 (Lauren Johnston)
Member id
UHC-59566-95
Confidence
1
Method
probabilistic
MBR-027505CLM-423872
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003413
Orphan claim re-pointed
Claims processor
CLM-400301 → UHC-98479-36 (Lauren Davis)
Member id
UHC-98479-36
Confidence
1
Method
probabilistic
MBR-000611CLM-400301
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003414
Orphan claim re-pointed
Claims processor
CLM-401703 → UHC-95931-01 (John Estrada)
Member id
UHC-95931-01
Confidence
0.97
Method
deterministic
MBR-014478CLM-401703
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003415
Orphan claim re-pointed
Claims processor
CLM-408792 → UHC-23112-90 (Angela Moreno)
Member id
UHC-23112-90
Confidence
0.89
Method
probabilistic
MBR-010131CLM-408792
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003416
Orphan claim re-pointed
Claims processor
CLM-406897 → UHC-41118-16 (Laura Kelly)
Member id
UHC-41118-16
Confidence
1
Method
probabilistic
MBR-011502CLM-406897
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003417
Orphan claim re-pointed
Claims processor
CLM-415889 → UHC-11747-32 (Natalie Murphy)
Member id
UHC-11747-32
Confidence
1
Method
probabilistic
MBR-020697CLM-415889
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003418
Orphan claim re-pointed
Claims processor
CLM-423320 → UHC-18546-96 (Harold Ramirez)
Member id
UHC-18546-96
Confidence
1
Method
probabilistic
MBR-011089CLM-423320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003419
Orphan claim re-pointed
Claims processor
CLM-406146 → UHC-02702-65 (Joyce Griffin)
Member id
UHC-02702-65
Confidence
1
Method
probabilistic
MBR-023997CLM-406146
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003420
Orphan claim re-pointed
Claims processor
CLM-410890 → UHC-91757-89 (Katherine Bell)
Member id
UHC-91757-89
Confidence
1
Method
probabilistic
MBR-026521CLM-410890
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003421
Orphan claim re-pointed
Claims processor
CLM-423385 → UHC-36010-48 (Barbara Patel)
Member id
UHC-36010-48
Confidence
1
Method
probabilistic
MBR-012928CLM-423385
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003422
Orphan claim re-pointed
Claims processor
CLM-426552 → UHC-10433-05 (Mason Palmer)
Member id
UHC-10433-05
Confidence
1
Method
probabilistic
MBR-000959CLM-426552
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003423
Orphan claim re-pointed
Claims processor
CLM-414919 → UHC-94540-99 (Jack Butler)
Member id
UHC-94540-99
Confidence
1
Method
probabilistic
MBR-001302CLM-414919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003424
Orphan claim re-pointed
Claims processor
CLM-401607 → UHC-89089-78 (Abigail Jordan)
Member id
UHC-89089-78
Confidence
0.97
Method
deterministic
MBR-031794CLM-401607
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003425
Orphan claim re-pointed
Claims processor
CLM-431443 → UHC-81453-36 (Emily Henderson)
Member id
UHC-81453-36
Confidence
1
Method
probabilistic
MBR-001073CLM-431443
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003426
Orphan claim re-pointed
Claims processor
CLM-420779 → UHC-15397-39 (Benjamin Gibson)
Member id
UHC-15397-39
Confidence
1
Method
probabilistic
MBR-005934CLM-420779
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003427
Orphan claim re-pointed
Claims processor
CLM-416952 → UHC-63367-57 (Elijah Richardson)
Member id
UHC-63367-57
Confidence
1
Method
probabilistic
MBR-004994CLM-416952
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003428
Orphan claim re-pointed
Claims processor
CLM-430531 → UHC-43689-66 (Christian Thomas)
Member id
UHC-43689-66
Confidence
1
Method
probabilistic
MBR-002668CLM-430531
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003429
Orphan claim re-pointed
Claims processor
CLM-409958 → UHC-49773-32 (Alice Armstrong)
Member id
UHC-49773-32
Confidence
0.97
Method
deterministic
MBR-015855CLM-409958
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003430
Orphan claim re-pointed
Claims processor
CLM-431920 → UHC-71352-96 (Bryan Grant)
Member id
UHC-71352-96
Confidence
1
Method
probabilistic
MBR-016604CLM-431920
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003431
Orphan claim re-pointed
Claims processor
CLM-424575 → UHC-95551-94 (Ann White)
Member id
UHC-95551-94
Confidence
1
Method
probabilistic
MBR-016265CLM-424575
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003432
Orphan claim re-pointed
Claims processor
CLM-421928 → UHC-08853-29 (Nancy Howard)
Member id
UHC-08853-29
Confidence
1
Method
probabilistic
MBR-009466CLM-421928
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003433
Orphan claim re-pointed
Claims processor
CLM-413457 → UHC-91524-18 (Barbara Edwards)
Member id
UHC-91524-18
Confidence
1
Method
probabilistic
MBR-013274CLM-413457
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003434
Orphan claim re-pointed
Claims processor
CLM-405173 → UHC-55685-78 (Barbara Silva)
Member id
UHC-55685-78
Confidence
1
Method
probabilistic
MBR-006832CLM-405173
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003435
Orphan claim re-pointed
Claims processor
CLM-406587 → UHC-60170-41 (Kelly Gordon)
Member id
UHC-60170-41
Confidence
1
Method
probabilistic
MBR-005425CLM-406587
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003436
Orphan claim re-pointed
Claims processor
CLM-405612 → UHC-44784-71 (Mariana Lane)
Member id
UHC-44784-71
Confidence
1
Method
probabilistic
MBR-033874CLM-405612
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003437
Orphan claim re-pointed
Claims processor
CLM-425062 → UHC-06290-50 (Kyle Miller)
Member id
UHC-06290-50
Confidence
1
Method
probabilistic
MBR-024041CLM-425062
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003438
Orphan claim re-pointed
Claims processor
CLM-430695 → UHC-46816-90 (Linda Banks)
Member id
UHC-46816-90
Confidence
0.93
Method
probabilistic
MBR-026651CLM-430695
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003439
Orphan claim re-pointed
Claims processor
CLM-409379 → UHC-29035-01 (Cynthia Morgan)
Member id
UHC-29035-01
Confidence
0.97
Method
deterministic
MBR-028900CLM-409379
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 42 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.