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-003890
Orphan claim re-pointed
Claims processor
CLM-406623 → UHC-53630-10 (Kathleen Graham)
Member id
UHC-53630-10
Confidence
1
Method
probabilistic
MBR-026388CLM-406623
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003891
Orphan claim re-pointed
Claims processor
CLM-419710 → UHC-99410-20 (Abby Arnold)
Member id
UHC-99410-20
Confidence
0.97
Method
deterministic
MBR-043766CLM-419710
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003892
Orphan claim re-pointed
Claims processor
CLM-403941 → UHC-72695-92 (Elijah Pena)
Member id
UHC-72695-92
Confidence
1
Method
probabilistic
MBR-031145CLM-403941
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003893
Orphan claim re-pointed
Claims processor
CLM-412579 → UHC-11667-88 (Shirley Sanchez)
Member id
UHC-11667-88
Confidence
0.97
Method
deterministic
MBR-012117CLM-412579
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003894
Orphan claim re-pointed
Claims processor
CLM-410096 → UHC-65603-12 (Gary Rodriguez)
Member id
UHC-65603-12
Confidence
1
Method
probabilistic
MBR-022270CLM-410096
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003895
Orphan claim re-pointed
Claims processor
CLM-405380 → UHC-83550-98 (Anthony Banks)
Member id
UHC-83550-98
Confidence
1
Method
probabilistic
MBR-028943CLM-405380
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003896
Orphan claim re-pointed
Claims processor
CLM-412227 → UHC-54651-03 (Megan Rios)
Member id
UHC-54651-03
Confidence
0.97
Method
deterministic
MBR-024914CLM-412227
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003897
Orphan claim re-pointed
Claims processor
CLM-408061 → UHC-99058-30 (Bruce Ward)
Member id
UHC-99058-30
Confidence
0.98
Method
probabilistic
MBR-007853CLM-408061
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003898
Orphan claim re-pointed
Claims processor
CLM-408258 → UHC-22039-25 (Walter Weber)
Member id
UHC-22039-25
Confidence
0.93
Method
probabilistic
MBR-039445CLM-408258
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003899
Orphan claim re-pointed
Claims processor
CLM-412765 → UHC-87809-79 (Steven Cook)
Member id
UHC-87809-79
Confidence
0.93
Method
probabilistic
MBR-026335CLM-412765
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003900
Orphan claim re-pointed
Claims processor
CLM-405128 → UHC-49921-75 (Denise Scott)
Member id
UHC-49921-75
Confidence
0.97
Method
deterministic
MBR-012017CLM-405128
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003901
Orphan claim re-pointed
Claims processor
CLM-417329 → UHC-18243-61 (Michael Flores)
Member id
UHC-18243-61
Confidence
1
Method
probabilistic
MBR-004183CLM-417329
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003902
Orphan claim re-pointed
Claims processor
CLM-413980 → UHC-58277-73 (Samuel Padilla)
Member id
UHC-58277-73
Confidence
0.97
Method
probabilistic
MBR-015925CLM-413980
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003903
Orphan claim re-pointed
Claims processor
CLM-424077 → UHC-63640-79 (Priya Ortiz)
Member id
UHC-63640-79
Confidence
1
Method
probabilistic
MBR-032320CLM-424077
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003904
Orphan claim re-pointed
Claims processor
CLM-409605 → UHC-12032-61 (Catherine Mendez)
Member id
UHC-12032-61
Confidence
0.93
Method
probabilistic
MBR-006988CLM-409605
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003905
Orphan claim re-pointed
Claims processor
CLM-428773 → UHC-33961-52 (Aaron Rojas)
Member id
UHC-33961-52
Confidence
1
Method
probabilistic
MBR-022552CLM-428773
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003906
Orphan claim re-pointed
Claims processor
CLM-417140 → UHC-77504-30 (Valentina Wood)
Member id
UHC-77504-30
Confidence
1
Method
probabilistic
MBR-011874CLM-417140
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003907
Orphan claim re-pointed
Claims processor
CLM-406622 → UHC-53630-10 (Kathleen Graham)
Member id
UHC-53630-10
Confidence
1
Method
probabilistic
MBR-026388CLM-406622
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003908
Orphan claim re-pointed
Claims processor
CLM-432817 → UHC-87647-23 (Brittany Reyes)
Member id
UHC-87647-23
Confidence
1
Method
probabilistic
MBR-010562CLM-432817
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003909
Orphan claim re-pointed
Claims processor
CLM-403624 → UHC-49193-58 (Jack Knight)
Member id
UHC-49193-58
Confidence
1
Method
probabilistic
MBR-030430CLM-403624
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003910
Orphan claim re-pointed
Claims processor
CLM-406128 → UHC-68864-27 (Michelle Nelson)
Member id
UHC-68864-27
Confidence
1
Method
probabilistic
MBR-027654CLM-406128
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003911
Orphan claim re-pointed
Claims processor
CLM-424707 → UHC-79738-91 (Nathan Yang)
Member id
UHC-79738-91
Confidence
1
Method
probabilistic
MBR-005531CLM-424707
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003912
Orphan claim re-pointed
Claims processor
CLM-400057 → UHC-53829-66 (Laura Hamilton)
Member id
UHC-53829-66
Confidence
0.99
Method
probabilistic
MBR-000365CLM-400057
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003913
Orphan claim re-pointed
Claims processor
CLM-404412 → UHC-70105-62 (Jeffrey Jordan)
Member id
UHC-70105-62
Confidence
1
Method
probabilistic
MBR-002603CLM-404412
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003914
Orphan claim re-pointed
Claims processor
CLM-402729 → UHC-92968-09 (Ana Coleman)
Member id
UHC-92968-09
Confidence
1
Method
probabilistic
MBR-004518CLM-402729
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003915
Orphan claim re-pointed
Claims processor
CLM-405474 → UHC-39661-50 (Albert Olson)
Member id
UHC-39661-50
Confidence
0.97
Method
deterministic
MBR-022569CLM-405474
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003916
Orphan claim re-pointed
Claims processor
CLM-407390 → UHC-52903-44 (Philip Dean)
Member id
UHC-52903-44
Confidence
0.99
Method
probabilistic
MBR-026107CLM-407390
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003917
Orphan claim re-pointed
Claims processor
CLM-402043 → UHC-47109-16 (Scott Shaw)
Member id
UHC-47109-16
Confidence
0.99
Method
probabilistic
MBR-003939CLM-402043
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003918
Orphan claim re-pointed
Claims processor
CLM-425071 → UHC-85183-78 (Joan Fowler)
Member id
UHC-85183-78
Confidence
0.98
Method
probabilistic
MBR-003885CLM-425071
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003919
Orphan claim re-pointed
Claims processor
CLM-413068 → UHC-57923-64 (Stephen Montgomery)
Member id
UHC-57923-64
Confidence
1
Method
probabilistic
MBR-011326CLM-413068
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003920
Orphan claim re-pointed
Claims processor
CLM-403995 → UHC-55267-90 (Virginia Cook)
Member id
UHC-55267-90
Confidence
1
Method
probabilistic
MBR-000603CLM-403995
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003921
Orphan claim re-pointed
Claims processor
CLM-418035 → UHC-77509-21 (William Williams)
Member id
UHC-77509-21
Confidence
1
Method
probabilistic
MBR-012226CLM-418035
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003922
Orphan claim re-pointed
Claims processor
CLM-427170 → UHC-11439-98 (Bryan Black)
Member id
UHC-11439-98
Confidence
1
Method
probabilistic
MBR-003456CLM-427170
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003923
Orphan claim re-pointed
Claims processor
CLM-405615 → UHC-02617-99 (Amber Garza)
Member id
UHC-02617-99
Confidence
1
Method
probabilistic
MBR-025105CLM-405615
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003924
Orphan claim re-pointed
Claims processor
CLM-407696 → UHC-94741-69 (Robert Weber)
Member id
UHC-94741-69
Confidence
1
Method
probabilistic
MBR-003015CLM-407696
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003925
Orphan claim re-pointed
Claims processor
CLM-419832 → UHC-52792-25 (Daniel Elliott)
Member id
UHC-52792-25
Confidence
1
Method
probabilistic
MBR-013941CLM-419832
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003926
Orphan claim re-pointed
Claims processor
CLM-407162 → UHC-30657-74 (Ryan Duncan)
Member id
UHC-30657-74
Confidence
1
Method
probabilistic
MBR-001461CLM-407162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003927
Orphan claim re-pointed
Claims processor
CLM-421455 → UHC-93320-87 (Bruce Jensen)
Member id
UHC-93320-87
Confidence
1
Method
probabilistic
MBR-014734CLM-421455
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003928
Orphan claim re-pointed
Claims processor
CLM-418817 → UHC-15997-66 (Henry Jordan)
Member id
UHC-15997-66
Confidence
1
Method
probabilistic
MBR-009883CLM-418817
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003929
Orphan claim re-pointed
Claims processor
CLM-430868 → UHC-22981-87 (Dennis Brown)
Member id
UHC-22981-87
Confidence
1
Method
probabilistic
MBR-016906CLM-430868
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003930
Orphan claim re-pointed
Claims processor
CLM-420752 → UHC-54629-26 (Mariana Arnold)
Member id
UHC-54629-26
Confidence
1
Method
probabilistic
MBR-015247CLM-420752
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003931
Orphan claim re-pointed
Claims processor
CLM-431204 → UHC-59050-84 (Bradley Jones)
Member id
UHC-59050-84
Confidence
1
Method
probabilistic
MBR-015973CLM-431204
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003932
Orphan claim re-pointed
Claims processor
CLM-423663 → UHC-34876-67 (Eugene Franklin)
Member id
UHC-34876-67
Confidence
1
Method
probabilistic
MBR-001018CLM-423663
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003933
Orphan claim re-pointed
Claims processor
CLM-411251 → UHC-98163-77 (Heather Webb)
Member id
UHC-98163-77
Confidence
1
Method
probabilistic
MBR-010511CLM-411251
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003934
Orphan claim re-pointed
Claims processor
CLM-411626 → UHC-14707-79 (Santiago Henry)
Member id
UHC-14707-79
Confidence
1
Method
probabilistic
MBR-017957CLM-411626
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003935
Orphan claim re-pointed
Claims processor
CLM-403696 → UHC-19046-98 (Christina Burke)
Member id
UHC-19046-98
Confidence
0.93
Method
probabilistic
MBR-042746CLM-403696
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003936
Orphan claim re-pointed
Claims processor
CLM-420518 → UHC-74228-68 (Abbby Wong)
Member id
UHC-74228-68
Confidence
0.93
Method
probabilistic
MBR-041276CLM-420518
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003937
Orphan claim re-pointed
Claims processor
CLM-429774 → UHC-49905-75 (Kathryn Wallace)
Member id
UHC-49905-75
Confidence
0.97
Method
deterministic
MBR-029216CLM-429774
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003938
Orphan claim re-pointed
Claims processor
CLM-402648 → UHC-17562-29 (George Brown)
Member id
UHC-17562-29
Confidence
1
Method
probabilistic
MBR-017757CLM-402648
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003939
Orphan claim re-pointed
Claims processor
CLM-428938 → UHC-10473-09 (Victoria Nunez)
Member id
UHC-10473-09
Confidence
1
Method
probabilistic
MBR-002654CLM-428938
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 52 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.