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-004690
Orphan claim re-pointed
Claims processor
CLM-403881 → UHC-12264-39 (Timothy Reed)
Member id
UHC-12264-39
Confidence
0.97
Method
deterministic
MBR-015413CLM-403881
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004691
Orphan claim re-pointed
Claims processor
CLM-415893 → UHC-36112-57 (Diego Lane)
Member id
UHC-36112-57
Confidence
1
Method
probabilistic
MBR-005983CLM-415893
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004692
Orphan claim re-pointed
Claims processor
CLM-432810 → UHC-08687-94 (Jennifer Cunningham)
Member id
UHC-08687-94
Confidence
1
Method
probabilistic
MBR-030232CLM-432810
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004693
Orphan claim re-pointed
Claims processor
CLM-408929 → UHC-92591-12 (Kevin Powell)
Member id
UHC-92591-12
Confidence
1
Method
probabilistic
MBR-030990CLM-408929
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004694
Orphan claim re-pointed
Claims processor
CLM-429355 → UHC-35404-84 (Isabella Shaw)
Member id
UHC-35404-84
Confidence
1
Method
probabilistic
MBR-027913CLM-429355
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004695
Orphan claim re-pointed
Claims processor
CLM-409446 → UHC-98481-53 (Joan Moore)
Member id
UHC-98481-53
Confidence
0.97
Method
deterministic
MBR-003082CLM-409446
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004696
Orphan claim re-pointed
Claims processor
CLM-406801 → UHC-22406-82 (Jacob King)
Member id
UHC-22406-82
Confidence
1
Method
probabilistic
MBR-001075CLM-406801
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004697
Orphan claim re-pointed
Claims processor
CLM-419954 → UHC-51257-13 (Joshua Jenkins)
Member id
UHC-51257-13
Confidence
1
Method
probabilistic
MBR-010789CLM-419954
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004698
Orphan claim re-pointed
Claims processor
CLM-408731 → UHC-29359-29 (Kathleen Harris)
Member id
UHC-29359-29
Confidence
0.97
Method
deterministic
MBR-025419CLM-408731
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004699
Orphan claim re-pointed
Claims processor
CLM-402395 → UHC-93922-74 (Randy Harrison)
Member id
UHC-93922-74
Confidence
1
Method
probabilistic
MBR-016777CLM-402395
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004700
Orphan claim re-pointed
Claims processor
CLM-427238 → UHC-80971-11 (Russell King)
Member id
UHC-80971-11
Confidence
0.90
Method
probabilistic
MBR-009481CLM-427238
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004701
Orphan claim re-pointed
Claims processor
CLM-412070 → UHC-05080-57 (Kevin Mejia)
Member id
UHC-05080-57
Confidence
1
Method
probabilistic
MBR-037558CLM-412070
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004702
Orphan claim re-pointed
Claims processor
CLM-404909 → UHC-20206-20 (Kathryn Carpenter)
Member id
UHC-20206-20
Confidence
1
Method
probabilistic
MBR-010993CLM-404909
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004703
Orphan claim re-pointed
Claims processor
CLM-427782 → UHC-24948-24 (Karen Nichols)
Member id
UHC-24948-24
Confidence
0.99
Method
probabilistic
MBR-000555CLM-427782
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004704
Orphan claim re-pointed
Claims processor
CLM-419550 → UHC-62381-32 (Bryan Walker)
Member id
UHC-62381-32
Confidence
1
Method
probabilistic
MBR-018076CLM-419550
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004705
Orphan claim re-pointed
Claims processor
CLM-414162 → UHC-34997-70 (Marc Maldonado)
Member id
UHC-34997-70
Confidence
0.99
Method
probabilistic
MBR-027847CLM-414162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004706
Orphan claim re-pointed
Claims processor
CLM-405886 → UHC-07705-11 (Ethan Robertson)
Member id
UHC-07705-11
Confidence
1
Method
probabilistic
MBR-018236CLM-405886
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004707
Orphan claim re-pointed
Claims processor
CLM-420046 → UHC-49350-55 (Isabella Wallace)
Member id
UHC-49350-55
Confidence
1
Method
probabilistic
MBR-000514CLM-420046
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004708
Orphan claim re-pointed
Claims processor
CLM-431436 → UHC-89581-24 (Dennis Bryant)
Member id
UHC-89581-24
Confidence
1
Method
probabilistic
MBR-034351CLM-431436
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004709
Orphan claim re-pointed
Claims processor
CLM-404966 → UHC-50684-94 (Sam Miller)
Member id
UHC-50684-94
Confidence
1
Method
probabilistic
MBR-006240CLM-404966
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004710
Orphan claim re-pointed
Claims processor
CLM-422891 → UHC-71180-40 (Douglas Matthews)
Member id
UHC-71180-40
Confidence
1
Method
probabilistic
MBR-022863CLM-422891
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004711
Orphan claim re-pointed
Claims processor
CLM-431956 → UHC-42973-31 (Danielle Cruz)
Member id
UHC-42973-31
Confidence
1
Method
probabilistic
MBR-013819CLM-431956
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004712
Orphan claim re-pointed
Claims processor
CLM-400960 → UHC-15651-83 (Patricia Le)
Member id
UHC-15651-83
Confidence
1
Method
probabilistic
MBR-002487CLM-400960
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004713
Orphan claim re-pointed
Claims processor
CLM-411167 → UHC-74741-25 (Jose Morrison)
Member id
UHC-74741-25
Confidence
1
Method
probabilistic
MBR-008883CLM-411167
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004714
Orphan claim re-pointed
Claims processor
CLM-421648 → UHC-54160-30 (Aaron Johnston)
Member id
UHC-54160-30
Confidence
0.97
Method
deterministic
MBR-046386CLM-421648
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004715
Orphan claim re-pointed
Claims processor
CLM-420220 → UHC-19964-20 (Ruth Pierce)
Member id
UHC-19964-20
Confidence
0.99
Method
probabilistic
MBR-000562CLM-420220
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004716
Orphan claim re-pointed
Claims processor
CLM-409864 → UHC-32255-61 (Nicole Woods)
Member id
UHC-32255-61
Confidence
1
Method
probabilistic
MBR-025860CLM-409864
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004717
Orphan claim re-pointed
Claims processor
CLM-430242 → UHC-60706-35 (Adam Cooper)
Member id
UHC-60706-35
Confidence
1
Method
probabilistic
MBR-037035CLM-430242
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004718
Orphan claim re-pointed
Claims processor
CLM-414235 → UHC-45897-76 (Lori Austin)
Member id
UHC-45897-76
Confidence
1
Method
probabilistic
MBR-007093CLM-414235
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004719
Orphan claim re-pointed
Claims processor
CLM-401466 → UHC-10719-99 (Barbara Ruiz)
Member id
UHC-10719-99
Confidence
1
Method
probabilistic
MBR-000222CLM-401466
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004720
Orphan claim re-pointed
Claims processor
CLM-417017 → UHC-45212-97 (Christina Stone)
Member id
UHC-45212-97
Confidence
1
Method
probabilistic
MBR-016931CLM-417017
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004721
Orphan claim re-pointed
Claims processor
CLM-412877 → UHC-84136-34 (Melissa Stevens)
Member id
UHC-84136-34
Confidence
1
Method
probabilistic
MBR-031184CLM-412877
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004722
Orphan claim re-pointed
Claims processor
CLM-416061 → UHC-95205-05 (Donald Matthews)
Member id
UHC-95205-05
Confidence
1
Method
probabilistic
MBR-028854CLM-416061
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004723
Orphan claim re-pointed
Claims processor
CLM-404646 → UHC-53091-93 (Angela Chapman)
Member id
UHC-53091-93
Confidence
0.97
Method
deterministic
MBR-022893CLM-404646
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004724
Orphan claim re-pointed
Claims processor
CLM-428162 → UHC-30097-39 (Shirley Vasquez)
Member id
UHC-30097-39
Confidence
1
Method
probabilistic
MBR-016792CLM-428162
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004725
Orphan claim re-pointed
Claims processor
CLM-416656 → UHC-21051-13 (Judith Simpson)
Member id
UHC-21051-13
Confidence
1
Method
probabilistic
MBR-024063CLM-416656
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004726
Orphan claim re-pointed
Claims processor
CLM-410949 → UHC-39292-35 (Lawrence Ortega)
Member id
UHC-39292-35
Confidence
1
Method
probabilistic
MBR-027990CLM-410949
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004727
Orphan claim re-pointed
Claims processor
CLM-406848 → UHC-12071-84 (Abby Mason)
Member id
UHC-12071-84
Confidence
0.97
Method
deterministic
MBR-008654CLM-406848
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004728
Orphan claim re-pointed
Claims processor
CLM-408787 → UHC-51039-01 (Jacob Hoffman)
Member id
UHC-51039-01
Confidence
0.97
Method
deterministic
MBR-011020CLM-408787
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004729
Orphan claim re-pointed
Claims processor
CLM-430316 → UHC-74911-42 (Ethan Weber)
Member id
UHC-74911-42
Confidence
1
Method
probabilistic
MBR-003393CLM-430316
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004730
Orphan claim re-pointed
Claims processor
CLM-424235 → UHC-05960-06 (Kayla Perry)
Member id
UHC-05960-06
Confidence
0.99
Method
probabilistic
MBR-034757CLM-424235
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004731
Orphan claim re-pointed
Claims processor
CLM-415947 → UHC-50761-37 (Jean Wilson)
Member id
UHC-50761-37
Confidence
0.97
Method
deterministic
MBR-035790CLM-415947
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004732
Orphan claim re-pointed
Claims processor
CLM-426745 → UHC-40588-93 (Brenda Butler)
Member id
UHC-40588-93
Confidence
0.97
Method
deterministic
MBR-007584CLM-426745
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004733
Orphan claim re-pointed
Claims processor
CLM-424664 → UHC-60560-81 (Alice Mejia)
Member id
UHC-60560-81
Confidence
1
Method
probabilistic
MBR-030620CLM-424664
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004734
Orphan claim re-pointed
Claims processor
CLM-421452 → UHC-36480-49 (Ralph Jimenez)
Member id
UHC-36480-49
Confidence
1
Method
probabilistic
MBR-008478CLM-421452
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004735
Orphan claim re-pointed
Claims processor
CLM-416265 → UHC-41663-21 (Jonathan Weaver)
Member id
UHC-41663-21
Confidence
1
Method
probabilistic
MBR-004486CLM-416265
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004736
Orphan claim re-pointed
Claims processor
CLM-402887 → UHC-08276-88 (Mark Cole)
Member id
UHC-08276-88
Confidence
1
Method
probabilistic
MBR-007195CLM-402887
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004737
Orphan claim re-pointed
Claims processor
CLM-413957 → UHC-69678-10 (Luis Dunn)
Member id
UHC-69678-10
Confidence
1
Method
probabilistic
MBR-013051CLM-413957
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004738
Orphan claim re-pointed
Claims processor
CLM-425157 → UHC-72647-57 (Sara Hoffman)
Member id
UHC-72647-57
Confidence
0.99
Method
probabilistic
MBR-002943CLM-425157
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004739
Orphan claim re-pointed
Claims processor
CLM-428777 → UHC-57440-22 (Jacob Grant)
Member id
UHC-57440-22
Confidence
1
Method
probabilistic
MBR-013379CLM-428777
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 68 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.