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-003990
Orphan claim re-pointed
Claims processor
CLM-431427 → UHC-22728-58 (Frances Gonzalez)
Member id
UHC-22728-58
Confidence
1
Method
probabilistic
MBR-018423CLM-431427
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003991
Orphan claim re-pointed
Claims processor
CLM-429410 → UHC-13009-12 (Raymond Day)
Member id
UHC-13009-12
Confidence
0.97
Method
deterministic
MBR-021516CLM-429410
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003992
Orphan claim re-pointed
Claims processor
CLM-431907 → UHC-49229-90 (Melissa Hudson)
Member id
UHC-49229-90
Confidence
1
Method
probabilistic
MBR-015560CLM-431907
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003993
Orphan claim re-pointed
Claims processor
CLM-424372 → UHC-51097-26 (Roger Sanders)
Member id
UHC-51097-26
Confidence
1
Method
probabilistic
MBR-007736CLM-424372
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003994
Orphan claim re-pointed
Claims processor
CLM-402931 → UHC-11323-44 (Gregory Morales)
Member id
UHC-11323-44
Confidence
1
Method
probabilistic
MBR-009727CLM-402931
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003995
Orphan claim re-pointed
Claims processor
CLM-413706 → UHC-85465-78 (Beverly Ruiz)
Member id
UHC-85465-78
Confidence
1
Method
probabilistic
MBR-034490CLM-413706
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003996
Orphan claim re-pointed
Claims processor
CLM-400645 → UHC-12852-84 (Willie Walsh)
Member id
UHC-12852-84
Confidence
1
Method
probabilistic
MBR-004666CLM-400645
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003997
Orphan claim re-pointed
Claims processor
CLM-414426 → UHC-58675-91 (Aisha Ryan)
Member id
UHC-58675-91
Confidence
0.98
Method
probabilistic
MBR-001604CLM-414426
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003998
Orphan claim re-pointed
Claims processor
CLM-411076 → UHC-47519-53 (Robert Stevens)
Member id
UHC-47519-53
Confidence
1
Method
probabilistic
MBR-012694CLM-411076
Executed
resolution_agent
2026-10-22 12:47:23
ACT-003999
Orphan claim re-pointed
Claims processor
CLM-420610 → UHC-72345-89 (Albert Ramos)
Member id
UHC-72345-89
Confidence
1
Method
probabilistic
MBR-002204CLM-420610
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004000
Orphan claim re-pointed
Claims processor
CLM-426919 → UHC-33271-88 (Omar Li)
Member id
UHC-33271-88
Confidence
1
Method
probabilistic
MBR-022335CLM-426919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004001
Orphan claim re-pointed
Claims processor
CLM-419896 → UHC-02823-72 (Susan Bradley)
Member id
UHC-02823-72
Confidence
1
Method
probabilistic
MBR-003031CLM-419896
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004002
Orphan claim re-pointed
Claims processor
CLM-418563 → UHC-01130-29 (Sean Adams)
Member id
UHC-01130-29
Confidence
1
Method
probabilistic
MBR-012351CLM-418563
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004003
Orphan claim re-pointed
Claims processor
CLM-422127 → UHC-48770-09 (Mary Walker)
Member id
UHC-48770-09
Confidence
0.97
Method
deterministic
MBR-020397CLM-422127
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004004
Orphan claim re-pointed
Claims processor
CLM-422264 → UHC-48770-91 (Marilyn Taylor)
Member id
UHC-48770-91
Confidence
0.94
Method
probabilistic
MBR-039170CLM-422264
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004005
Orphan claim re-pointed
Claims processor
CLM-429391 → UHC-42496-47 (Emily Roberts)
Member id
UHC-42496-47
Confidence
1
Method
probabilistic
MBR-000251CLM-429391
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004006
Orphan claim re-pointed
Claims processor
CLM-404606 → UHC-76091-41 (Susan Kennedy)
Member id
UHC-76091-41
Confidence
1
Method
probabilistic
MBR-006593CLM-404606
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004007
Orphan claim re-pointed
Claims processor
CLM-426374 → UHC-10097-24 (Sharon Salazar)
Member id
UHC-10097-24
Confidence
1
Method
probabilistic
MBR-021868CLM-426374
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004008
Orphan claim re-pointed
Claims processor
CLM-412987 → UHC-79196-55 (Olivia Washington)
Member id
UHC-79196-55
Confidence
0.93
Method
probabilistic
MBR-019629CLM-412987
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004009
Orphan claim re-pointed
Claims processor
CLM-407441 → UHC-50936-17 (Evalyn Burke)
Member id
UHC-50936-17
Confidence
0.97
Method
deterministic
MBR-008809CLM-407441
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004010
Orphan claim re-pointed
Claims processor
CLM-422123 → UHC-31111-49 (Sara Estrada)
Member id
UHC-31111-49
Confidence
1
Method
probabilistic
MBR-025408CLM-422123
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004011
Orphan claim re-pointed
Claims processor
CLM-408876 → UHC-41515-84 (Bruce Perkins)
Member id
UHC-41515-84
Confidence
1
Method
probabilistic
MBR-032349CLM-408876
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004012
Orphan claim re-pointed
Claims processor
CLM-413701 → UHC-94110-47 (Vincent Ruiz)
Member id
UHC-94110-47
Confidence
1
Method
probabilistic
MBR-019601CLM-413701
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004013
Orphan claim re-pointed
Claims processor
CLM-425529 → UHC-34433-48 (Scott Johnston)
Member id
UHC-34433-48
Confidence
1
Method
probabilistic
MBR-006216CLM-425529
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004014
Orphan claim re-pointed
Claims processor
CLM-423304 → UHC-41301-41 (Arjun Scott)
Member id
UHC-41301-41
Confidence
1
Method
probabilistic
MBR-013677CLM-423304
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004015
Orphan claim re-pointed
Claims processor
CLM-415077 → UHC-59750-05 (Mariana Robertson)
Member id
UHC-59750-05
Confidence
1
Method
probabilistic
MBR-014889CLM-415077
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004016
Orphan claim re-pointed
Claims processor
CLM-414590 → UHC-07734-45 (Larry Franklin)
Member id
UHC-07734-45
Confidence
0.97
Method
deterministic
MBR-007267CLM-414590
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004017
Orphan claim re-pointed
Claims processor
CLM-403125 → UHC-84056-95 (Nicholas Carter)
Member id
UHC-84056-95
Confidence
1
Method
probabilistic
MBR-015183CLM-403125
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004018
Orphan claim re-pointed
Claims processor
CLM-417283 → UHC-25481-39 (Robert Jacobs)
Member id
UHC-25481-39
Confidence
1
Method
probabilistic
MBR-018340CLM-417283
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004019
Orphan claim re-pointed
Claims processor
CLM-418059 → UHC-48631-14 (Dorothy Austin)
Member id
UHC-48631-14
Confidence
1
Method
probabilistic
MBR-006487CLM-418059
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004020
Orphan claim re-pointed
Claims processor
CLM-403178 → UHC-09651-87 (Joe Stephens)
Member id
UHC-09651-87
Confidence
1
Method
probabilistic
MBR-035777CLM-403178
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004021
Orphan claim re-pointed
Claims processor
CLM-418104 → UHC-19280-61 (Billy Vega)
Member id
UHC-19280-61
Confidence
0.97
Method
deterministic
MBR-007483CLM-418104
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004022
Orphan claim re-pointed
Claims processor
CLM-418142 → UHC-70156-56 (Alexis Ortega)
Member id
UHC-70156-56
Confidence
1
Method
probabilistic
MBR-005764CLM-418142
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004023
Orphan claim re-pointed
Claims processor
CLM-407133 → UHC-67835-89 (Sofia Thomas)
Member id
UHC-67835-89
Confidence
1
Method
probabilistic
MBR-018381CLM-407133
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004024
Orphan claim re-pointed
Claims processor
CLM-414582 → UHC-59640-98 (Angela Munoz)
Member id
UHC-59640-98
Confidence
0.97
Method
deterministic
MBR-011856CLM-414582
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004025
Orphan claim re-pointed
Claims processor
CLM-429758 → UHC-12907-68 (Betty Henderson)
Member id
UHC-12907-68
Confidence
1
Method
probabilistic
MBR-017920CLM-429758
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004026
Orphan claim re-pointed
Claims processor
CLM-413512 → UHC-68644-16 (Mary Jacobs)
Member id
UHC-68644-16
Confidence
1
Method
probabilistic
MBR-000828CLM-413512
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004027
Orphan claim re-pointed
Claims processor
CLM-429411 → UHC-13009-12 (Raymond Day)
Member id
UHC-13009-12
Confidence
0.97
Method
deterministic
MBR-021516CLM-429411
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004028
Orphan claim re-pointed
Claims processor
CLM-429304 → UHC-72399-15 (Kimberly Boyd)
Member id
UHC-72399-15
Confidence
1
Method
probabilistic
MBR-003776CLM-429304
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004029
Orphan claim re-pointed
Claims processor
CLM-408177 → UHC-31352-78 (Joyce Montgomery)
Member id
UHC-31352-78
Confidence
1
Method
probabilistic
MBR-033608CLM-408177
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004030
Orphan claim re-pointed
Claims processor
CLM-417367 → UHC-17090-46 (Joyce Medina)
Member id
UHC-17090-46
Confidence
1
Method
probabilistic
MBR-019930CLM-417367
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004031
Orphan claim re-pointed
Claims processor
CLM-423822 → UHC-86408-56 (Larry Reed)
Member id
UHC-86408-56
Confidence
0.97
Method
deterministic
MBR-017870CLM-423822
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004032
Orphan claim re-pointed
Claims processor
CLM-425417 → UHC-09047-81 (Samantha Palmer)
Member id
UHC-09047-81
Confidence
0.93
Method
probabilistic
MBR-014063CLM-425417
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004033
Orphan claim re-pointed
Claims processor
CLM-412062 → UHC-08393-09 (Emily Schultz)
Member id
UHC-08393-09
Confidence
0.92
Method
probabilistic
MBR-017879CLM-412062
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004034
Orphan claim re-pointed
Claims processor
CLM-424116 → UHC-54403-51 (Frank Lawrence)
Member id
UHC-54403-51
Confidence
1
Method
probabilistic
MBR-008217CLM-424116
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004035
Orphan claim re-pointed
Claims processor
CLM-404589 → UHC-13779-44 (Lawrence Ray)
Member id
UHC-13779-44
Confidence
0.97
Method
deterministic
MBR-007107CLM-404589
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004036
Orphan claim re-pointed
Claims processor
CLM-412553 → UHC-29225-61 (Wayne Rojas)
Member id
UHC-29225-61
Confidence
0.97
Method
deterministic
MBR-001118CLM-412553
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004037
Orphan claim re-pointed
Claims processor
CLM-402612 → UHC-08708-37 (Adam Long)
Member id
UHC-08708-37
Confidence
1
Method
probabilistic
MBR-003153CLM-402612
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004038
Orphan claim re-pointed
Claims processor
CLM-402582 → UHC-09959-89 (Philip Crawford)
Member id
UHC-09959-89
Confidence
1
Method
probabilistic
MBR-036725CLM-402582
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004039
Orphan claim re-pointed
Claims processor
CLM-416624 → UHC-37629-09 (Dennis Vargas)
Member id
UHC-37629-09
Confidence
1
Method
probabilistic
MBR-001650CLM-416624
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 54 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.