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-001590
Orphan claim re-pointed
Claims processor
CLM-425526 → UHC-84998-85 (Zachary Wheeler)
Member id
UHC-84998-85
Confidence
0.97
Method
deterministic
MBR-021439CLM-425526
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001591
Orphan claim re-pointed
Claims processor
CLM-429259 → UHC-28029-33 (Frank Evans)
Member id
UHC-28029-33
Confidence
0.97
Method
deterministic
MBR-018172CLM-429259
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001592
Orphan claim re-pointed
Claims processor
CLM-405560 → UHC-90923-96 (Isabella Pena)
Member id
UHC-90923-96
Confidence
1
Method
probabilistic
MBR-040148CLM-405560
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001593
Orphan claim re-pointed
Claims processor
CLM-404049 → UHC-76731-09 (Sophia Dixon)
Member id
UHC-76731-09
Confidence
1
Method
probabilistic
MBR-019505CLM-404049
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001594
Orphan claim re-pointed
Claims processor
CLM-428618 → UHC-59751-23 (Jack Yang)
Member id
UHC-59751-23
Confidence
1
Method
probabilistic
MBR-000048CLM-428618
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001595
Orphan claim re-pointed
Claims processor
CLM-427698 → UHC-04644-40 (Sharon Rojas)
Member id
UHC-04644-40
Confidence
0.97
Method
deterministic
MBR-021276CLM-427698
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001596
Orphan claim re-pointed
Claims processor
CLM-419050 → UHC-53279-40 (Jesse Wood)
Member id
UHC-53279-40
Confidence
1
Method
probabilistic
MBR-023756CLM-419050
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001597
Orphan claim re-pointed
Claims processor
CLM-409435 → UHC-31790-37 (Evelyn Owens)
Member id
UHC-31790-37
Confidence
1
Method
probabilistic
MBR-002107CLM-409435
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001598
Orphan claim re-pointed
Claims processor
CLM-424027 → UHC-57726-03 (Yuki Evans)
Member id
UHC-57726-03
Confidence
0.93
Method
probabilistic
MBR-027621CLM-424027
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001599
Orphan claim re-pointed
Claims processor
CLM-408163 → UHC-68692-47 (Philip Black)
Member id
UHC-68692-47
Confidence
0.97
Method
probabilistic
MBR-014096CLM-408163
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001600
Orphan claim re-pointed
Claims processor
CLM-431768 → UHC-50152-63 (Hiroshi Day)
Member id
UHC-50152-63
Confidence
1
Method
probabilistic
MBR-009117CLM-431768
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001601
Orphan claim re-pointed
Claims processor
CLM-432393 → UHC-50578-50 (Beverly Carlson)
Member id
UHC-50578-50
Confidence
0.97
Method
deterministic
MBR-030592CLM-432393
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001602
Orphan claim re-pointed
Claims processor
CLM-408855 → UHC-41752-65 (Martha Rogers)
Member id
UHC-41752-65
Confidence
1
Method
probabilistic
MBR-022671CLM-408855
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001603
Orphan claim re-pointed
Claims processor
CLM-404166 → UHC-64798-78 (Larry Franklin)
Member id
UHC-64798-78
Confidence
0.97
Method
deterministic
MBR-027054CLM-404166
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001604
Orphan claim re-pointed
Claims processor
CLM-401675 → UHC-05909-14 (Donald Hudson)
Member id
UHC-05909-14
Confidence
0.97
Method
deterministic
MBR-030189CLM-401675
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001605
Orphan claim re-pointed
Claims processor
CLM-406970 → UHC-83312-34 (Matthew Boyd)
Member id
UHC-83312-34
Confidence
0.97
Method
probabilistic
MBR-025986CLM-406970
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001606
Orphan claim re-pointed
Claims processor
CLM-417174 → UHC-90056-35 (Carolyn Coleman)
Member id
UHC-90056-35
Confidence
0.97
Method
deterministic
MBR-042025CLM-417174
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001607
Orphan claim re-pointed
Claims processor
CLM-405134 → UHC-00613-90 (James Henderson)
Member id
UHC-00613-90
Confidence
0.97
Method
deterministic
MBR-041688CLM-405134
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001608
Orphan claim re-pointed
Claims processor
CLM-409493 → UHC-14810-76 (Nathan Cunningham)
Member id
UHC-14810-76
Confidence
1
Method
probabilistic
MBR-000595CLM-409493
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001609
Orphan claim re-pointed
Claims processor
CLM-406262 → UHC-42998-10 (Larry Hall)
Member id
UHC-42998-10
Confidence
1
Method
probabilistic
MBR-003025CLM-406262
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001610
Orphan claim re-pointed
Claims processor
CLM-423308 → UHC-61253-61 (Justin Tucker)
Member id
UHC-61253-61
Confidence
1
Method
probabilistic
MBR-007500CLM-423308
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001611
Orphan claim re-pointed
Claims processor
CLM-407081 → UHC-49611-17 (Andrew Fisher)
Member id
UHC-49611-17
Confidence
1
Method
probabilistic
MBR-023097CLM-407081
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001612
Orphan claim re-pointed
Claims processor
CLM-418182 → UHC-20019-45 (Maria Medina)
Member id
UHC-20019-45
Confidence
1
Method
probabilistic
MBR-021422CLM-418182
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001613
Orphan claim re-pointed
Claims processor
CLM-423210 → UHC-60287-08 (Elijah Wells)
Member id
UHC-60287-08
Confidence
0.97
Method
deterministic
MBR-018398CLM-423210
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001614
Orphan claim re-pointed
Claims processor
CLM-421331 → UHC-39834-55 (Jean Davis)
Member id
UHC-39834-55
Confidence
0.97
Method
deterministic
MBR-008224CLM-421331
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001615
Orphan claim re-pointed
Claims processor
CLM-411924 → UHC-75741-71 (Kimberly Hunter)
Member id
UHC-75741-71
Confidence
1
Method
probabilistic
MBR-011992CLM-411924
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001616
Orphan claim re-pointed
Claims processor
CLM-419217 → UHC-96383-74 (Jerry Martin)
Member id
UHC-96383-74
Confidence
1
Method
probabilistic
MBR-034738CLM-419217
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001617
Orphan claim re-pointed
Claims processor
CLM-430346 → UHC-69597-53 (Hiroshi Tran)
Member id
UHC-69597-53
Confidence
1
Method
probabilistic
MBR-003751CLM-430346
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001618
Orphan claim re-pointed
Claims processor
CLM-413745 → UHC-63752-52 (Marcus Burke)
Member id
UHC-63752-52
Confidence
1
Method
probabilistic
MBR-039643CLM-413745
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001619
Orphan claim re-pointed
Claims processor
CLM-401160 → UHC-09214-53 (Dorothy Jackson)
Member id
UHC-09214-53
Confidence
0.97
Method
deterministic
MBR-023080CLM-401160
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001620
Orphan claim re-pointed
Claims processor
CLM-406161 → UHC-17519-92 (Noah Bryant)
Member id
UHC-17519-92
Confidence
1
Method
probabilistic
MBR-026500CLM-406161
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001621
Orphan claim re-pointed
Claims processor
CLM-400801 → UHC-91481-56 (Randy Sanchez)
Member id
UHC-91481-56
Confidence
1
Method
probabilistic
MBR-012120CLM-400801
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001622
Orphan claim re-pointed
Claims processor
CLM-413283 → UHC-75080-03 (Samuel Rivera)
Member id
UHC-75080-03
Confidence
1
Method
probabilistic
MBR-023315CLM-413283
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001623
Orphan claim re-pointed
Claims processor
CLM-411318 → UHC-59588-79 (Betty Rojas)
Member id
UHC-59588-79
Confidence
0.98
Method
probabilistic
MBR-010963CLM-411318
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001624
Orphan claim re-pointed
Claims processor
CLM-412278 → UHC-43012-07 (Terry Elliott)
Member id
UHC-43012-07
Confidence
1
Method
probabilistic
MBR-006050CLM-412278
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001625
Orphan claim re-pointed
Claims processor
CLM-420707 → UHC-73110-21 (Peter Jenkins)
Member id
UHC-73110-21
Confidence
0.97
Method
deterministic
MBR-014628CLM-420707
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001626
Orphan claim re-pointed
Claims processor
CLM-432447 → UHC-08660-19 (Christina Cooper)
Member id
UHC-08660-19
Confidence
0.99
Method
probabilistic
MBR-007497CLM-432447
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001627
Orphan claim re-pointed
Claims processor
CLM-429287 → UHC-41416-73 (Bobby Wilson)
Member id
UHC-41416-73
Confidence
1
Method
probabilistic
MBR-023623CLM-429287
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001628
Orphan claim re-pointed
Claims processor
CLM-425737 → UHC-89369-21 (Arjun Marshall)
Member id
UHC-89369-21
Confidence
0.97
Method
deterministic
MBR-021919CLM-425737
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001629
Orphan claim re-pointed
Claims processor
CLM-404449 → UHC-66696-56 (Justin Crawford)
Member id
UHC-66696-56
Confidence
1
Method
probabilistic
MBR-017589CLM-404449
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001630
Orphan claim re-pointed
Claims processor
CLM-409829 → UHC-89460-83 (Roger Lewis)
Member id
UHC-89460-83
Confidence
1
Method
probabilistic
MBR-011247CLM-409829
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001631
Orphan claim re-pointed
Claims processor
CLM-415241 → UHC-34996-49 (Ann Gonzalez)
Member id
UHC-34996-49
Confidence
0.99
Method
probabilistic
MBR-023972CLM-415241
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001632
Orphan claim re-pointed
Claims processor
CLM-430498 → UHC-72190-33 (Ray Peters)
Member id
UHC-72190-33
Confidence
1.00
Method
probabilistic
MBR-005750CLM-430498
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001633
Orphan claim re-pointed
Claims processor
CLM-414272 → UHC-83331-37 (Adam Harper)
Member id
UHC-83331-37
Confidence
0.97
Method
deterministic
MBR-027151CLM-414272
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001634
Orphan claim re-pointed
Claims processor
CLM-401924 → UHC-30222-34 (Teresa Harvey)
Member id
UHC-30222-34
Confidence
0.99
Method
probabilistic
MBR-031394CLM-401924
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001635
Orphan claim re-pointed
Claims processor
CLM-412011 → UHC-70117-04 (Jose Campbell)
Member id
UHC-70117-04
Confidence
1
Method
probabilistic
MBR-013302CLM-412011
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001636
Orphan claim re-pointed
Claims processor
CLM-407284 → UHC-97077-15 (Dylan Rojas)
Member id
UHC-97077-15
Confidence
1
Method
probabilistic
MBR-007714CLM-407284
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001637
Orphan claim re-pointed
Claims processor
CLM-413703 → UHC-99637-94 (Carol Parker)
Member id
UHC-99637-94
Confidence
0.98
Method
probabilistic
MBR-018479CLM-413703
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001638
Orphan claim re-pointed
Claims processor
CLM-403756 → UHC-80360-58 (Amy Alvarado)
Member id
UHC-80360-58
Confidence
1
Method
probabilistic
MBR-003107CLM-403756
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001639
Orphan claim re-pointed
Claims processor
CLM-422962 → UHC-18077-63 (Debra Hoffman)
Member id
UHC-18077-63
Confidence
0.99
Method
probabilistic
MBR-017186CLM-422962
Executed
resolution_agent
2026-10-19 19:54:39
14,086 rows, page 6 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.