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-004090
Orphan claim re-pointed
Claims processor
CLM-412195 → UHC-50591-44 (Andrew Gibson)
Member id
UHC-50591-44
Confidence
0.92
Method
probabilistic
MBR-007670CLM-412195
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004091
Orphan claim re-pointed
Claims processor
CLM-418745 → UHC-46631-14 (Marilyn Barnes)
Member id
UHC-46631-14
Confidence
0.89
Method
probabilistic
MBR-044265CLM-418745
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004092
Orphan claim re-pointed
Claims processor
CLM-415760 → UHC-95902-85 (Michael Anderson)
Member id
UHC-95902-85
Confidence
1
Method
probabilistic
MBR-006667CLM-415760
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004093
Orphan claim re-pointed
Claims processor
CLM-405581 → UHC-80972-01 (Hiroshi Espinoza)
Member id
UHC-80972-01
Confidence
1
Method
probabilistic
MBR-009281CLM-405581
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004094
Orphan claim re-pointed
Claims processor
CLM-411406 → UHC-99708-59 (Timothy Howell)
Member id
UHC-99708-59
Confidence
0.97
Method
deterministic
MBR-032109CLM-411406
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004095
Orphan claim re-pointed
Claims processor
CLM-412610 → UHC-85547-14 (Christopher Chavez)
Member id
UHC-85547-14
Confidence
0.97
Method
deterministic
MBR-006103CLM-412610
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004096
Orphan claim re-pointed
Claims processor
CLM-408858 → UHC-34441-71 (Luis Cox)
Member id
UHC-34441-71
Confidence
1
Method
probabilistic
MBR-038509CLM-408858
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004097
Orphan claim re-pointed
Claims processor
CLM-418742 → UHC-17595-06 (Ronald Long)
Member id
UHC-17595-06
Confidence
1
Method
probabilistic
MBR-024955CLM-418742
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004098
Orphan claim re-pointed
Claims processor
CLM-415822 → UHC-68765-36 (Diane Snyder)
Member id
UHC-68765-36
Confidence
1
Method
probabilistic
MBR-032467CLM-415822
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004099
Orphan claim re-pointed
Claims processor
CLM-402827 → UHC-16007-69 (Ruth Wells)
Member id
UHC-16007-69
Confidence
1
Method
probabilistic
MBR-018582CLM-402827
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004100
Orphan claim re-pointed
Claims processor
CLM-418297 → UHC-16985-12 (Linda Obrien)
Member id
UHC-16985-12
Confidence
1
Method
probabilistic
MBR-005356CLM-418297
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004101
Orphan claim re-pointed
Claims processor
CLM-403371 → UHC-46436-46 (Julia Dean)
Member id
UHC-46436-46
Confidence
1
Method
probabilistic
MBR-010733CLM-403371
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004102
Orphan claim re-pointed
Claims processor
CLM-415147 → UHC-51560-75 (Aaron Evans)
Member id
UHC-51560-75
Confidence
1
Method
probabilistic
MBR-028645CLM-415147
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004103
Orphan claim re-pointed
Claims processor
CLM-405903 → UHC-32257-08 (Alexander Reed)
Member id
UHC-32257-08
Confidence
1
Method
probabilistic
MBR-012168CLM-405903
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004104
Orphan claim re-pointed
Claims processor
CLM-423917 → UHC-10089-20 (Lisa Wong)
Member id
UHC-10089-20
Confidence
0.98
Method
probabilistic
MBR-018974CLM-423917
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004105
Orphan claim re-pointed
Claims processor
CLM-421482 → UHC-78896-24 (Jeffrey Sims)
Member id
UHC-78896-24
Confidence
1
Method
probabilistic
MBR-018063CLM-421482
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004106
Orphan claim re-pointed
Claims processor
CLM-426062 → UHC-87673-57 (Amanda Little)
Member id
UHC-87673-57
Confidence
0.93
Method
probabilistic
MBR-022181CLM-426062
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004107
Orphan claim re-pointed
Claims processor
CLM-424846 → UHC-25707-51 (Michelle Gutierrez)
Member id
UHC-25707-51
Confidence
1
Method
probabilistic
MBR-011893CLM-424846
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004108
Orphan claim re-pointed
Claims processor
CLM-429517 → UHC-80595-34 (Julia Luna)
Member id
UHC-80595-34
Confidence
1
Method
probabilistic
MBR-006921CLM-429517
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004109
Orphan claim re-pointed
Claims processor
CLM-400800 → UHC-42409-28 (Laura Sullivan)
Member id
UHC-42409-28
Confidence
1
Method
probabilistic
MBR-000220CLM-400800
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004110
Orphan claim re-pointed
Claims processor
CLM-402893 → UHC-01879-27 (Christian Wilson)
Member id
UHC-01879-27
Confidence
0.99
Method
probabilistic
MBR-020403CLM-402893
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004111
Orphan claim re-pointed
Claims processor
CLM-429726 → UHC-15473-96 (Charlotte Rojas)
Member id
UHC-15473-96
Confidence
0.97
Method
deterministic
MBR-041293CLM-429726
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004112
Orphan claim re-pointed
Claims processor
CLM-421815 → UHC-31609-15 (Willie Allen)
Member id
UHC-31609-15
Confidence
1
Method
probabilistic
MBR-026954CLM-421815
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004113
Orphan claim re-pointed
Claims processor
CLM-417498 → UHC-97981-14 (Emily Williams)
Member id
UHC-97981-14
Confidence
0.89
Method
probabilistic
MBR-023514CLM-417498
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004114
Orphan claim re-pointed
Claims processor
CLM-423968 → UHC-77804-72 (Jonathan Dominguez)
Member id
UHC-77804-72
Confidence
1
Method
probabilistic
MBR-018373CLM-423968
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004115
Orphan claim re-pointed
Claims processor
CLM-404858 → UHC-20418-29 (Arthur Harris)
Member id
UHC-20418-29
Confidence
1
Method
probabilistic
MBR-012217CLM-404858
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004116
Orphan claim re-pointed
Claims processor
CLM-427110 → UHC-98826-91 (Isabella Barnes)
Member id
UHC-98826-91
Confidence
0.97
Method
deterministic
MBR-018152CLM-427110
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004117
Orphan claim re-pointed
Claims processor
CLM-405993 → UHC-85275-26 (Lauren Taylor)
Member id
UHC-85275-26
Confidence
1
Method
probabilistic
MBR-012308CLM-405993
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004118
Orphan claim re-pointed
Claims processor
CLM-421922 → UHC-34912-88 (Theresa Henry)
Member id
UHC-34912-88
Confidence
1
Method
probabilistic
MBR-016456CLM-421922
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004119
Orphan claim re-pointed
Claims processor
CLM-412852 → UHC-02361-56 (Judith Vasquez)
Member id
UHC-02361-56
Confidence
1
Method
probabilistic
MBR-001640CLM-412852
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004120
Orphan claim re-pointed
Claims processor
CLM-422228 → UHC-14730-39 (Gerald Hicks)
Member id
UHC-14730-39
Confidence
0.99
Method
probabilistic
MBR-017162CLM-422228
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004121
Orphan claim re-pointed
Claims processor
CLM-414280 → UHC-32071-63 (Linda Torres)
Member id
UHC-32071-63
Confidence
1
Method
probabilistic
MBR-013316CLM-414280
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004122
Orphan claim re-pointed
Claims processor
CLM-408013 → UHC-05946-53 (Rachel Romero)
Member id
UHC-05946-53
Confidence
0.91
Method
probabilistic
MBR-010768CLM-408013
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004123
Orphan claim re-pointed
Claims processor
CLM-425352 → UHC-78785-52 (Carl Hunt)
Member id
UHC-78785-52
Confidence
0.97
Method
deterministic
MBR-024849CLM-425352
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004124
Orphan claim re-pointed
Claims processor
CLM-411381 → UHC-09658-23 (Jdy Miller)
Member id
UHC-09658-23
Confidence
0.99
Method
probabilistic
MBR-001952CLM-411381
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004125
Orphan claim re-pointed
Claims processor
CLM-405391 → UHC-48174-87 (Andrew Burke)
Member id
UHC-48174-87
Confidence
0.97
Method
deterministic
MBR-002726CLM-405391
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004126
Orphan claim re-pointed
Claims processor
CLM-412175 → UHC-36745-76 (Sean Fuller)
Member id
UHC-36745-76
Confidence
1
Method
probabilistic
MBR-005429CLM-412175
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004127
Orphan claim re-pointed
Claims processor
CLM-424716 → UHC-15360-01 (Daniel Jordan)
Member id
UHC-15360-01
Confidence
1
Method
probabilistic
MBR-009084CLM-424716
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004128
Orphan claim re-pointed
Claims processor
CLM-428919 → UHC-26103-13 (Austin Willis)
Member id
UHC-26103-13
Confidence
1
Method
probabilistic
MBR-006266CLM-428919
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004129
Orphan claim re-pointed
Claims processor
CLM-408847 → UHC-95280-49 (Diego Parker)
Member id
UHC-95280-49
Confidence
0.97
Method
deterministic
MBR-026110CLM-408847
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004130
Orphan claim re-pointed
Claims processor
CLM-419388 → UHC-95109-52 (Shirley Gutierrez)
Member id
UHC-95109-52
Confidence
1
Method
probabilistic
MBR-012249CLM-419388
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004131
Orphan claim re-pointed
Claims processor
CLM-405340 → UHC-27600-40 (Luis Hill)
Member id
UHC-27600-40
Confidence
0.97
Method
deterministic
MBR-010983CLM-405340
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004132
Orphan claim re-pointed
Claims processor
CLM-420432 → UHC-14557-08 (Charles Little)
Member id
UHC-14557-08
Confidence
0.97
Method
deterministic
MBR-006556CLM-420432
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004133
Orphan claim re-pointed
Claims processor
CLM-404561 → UHC-45682-55 (David Daniels)
Member id
UHC-45682-55
Confidence
0.97
Method
deterministic
MBR-003333CLM-404561
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004134
Orphan claim re-pointed
Claims processor
CLM-432318 → UHC-10590-48 (Emma Fields)
Member id
UHC-10590-48
Confidence
0.99
Method
probabilistic
MBR-006736CLM-432318
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004135
Orphan claim re-pointed
Claims processor
CLM-402868 → UHC-31158-95 (Danielle Ruiz)
Member id
UHC-31158-95
Confidence
0.97
Method
deterministic
MBR-003133CLM-402868
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004136
Orphan claim re-pointed
Claims processor
CLM-424370 → UHC-28455-24 (Peter Alvarez)
Member id
UHC-28455-24
Confidence
1
Method
probabilistic
MBR-022797CLM-424370
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004137
Orphan claim re-pointed
Claims processor
CLM-424928 → UHC-91159-53 (Diane George)
Member id
UHC-91159-53
Confidence
1
Method
probabilistic
MBR-032361CLM-424928
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004138
Orphan claim re-pointed
Claims processor
CLM-408665 → UHC-99908-37 (Mary George)
Member id
UHC-99908-37
Confidence
0.97
Method
deterministic
MBR-000829CLM-408665
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004139
Orphan claim re-pointed
Claims processor
CLM-411741 → UHC-26060-45 (Priya Tucker)
Member id
UHC-26060-45
Confidence
1
Method
probabilistic
MBR-001814CLM-411741
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 56 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.