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-001640
Orphan claim re-pointed
Claims processor
CLM-409991 → UHC-44921-94 (Mark Washington)
Member id
UHC-44921-94
Confidence
1
Method
probabilistic
MBR-000578CLM-409991
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001641
Orphan claim re-pointed
Claims processor
CLM-427622 → UHC-71503-66 (Jose Bradley)
Member id
UHC-71503-66
Confidence
0.97
Method
deterministic
MBR-002461CLM-427622
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001642
Orphan claim re-pointed
Claims processor
CLM-413823 → UHC-28890-43 (Madison Jenkins)
Member id
UHC-28890-43
Confidence
1
Method
probabilistic
MBR-040823CLM-413823
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001643
Orphan claim re-pointed
Claims processor
CLM-430928 → UHC-71924-51 (Jason Meyer)
Member id
UHC-71924-51
Confidence
1
Method
probabilistic
MBR-013575CLM-430928
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001644
Orphan claim re-pointed
Claims processor
CLM-418000 → UHC-73816-85 (Hiroshi Little)
Member id
UHC-73816-85
Confidence
0.97
Method
deterministic
MBR-035620CLM-418000
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001645
Orphan claim re-pointed
Claims processor
CLM-410715 → UHC-43965-26 (Harold Nelson)
Member id
UHC-43965-26
Confidence
1
Method
probabilistic
MBR-020249CLM-410715
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001646
Orphan claim re-pointed
Claims processor
CLM-410694 → UHC-84665-74 (David Woods)
Member id
UHC-84665-74
Confidence
1
Method
probabilistic
MBR-001635CLM-410694
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001647
Orphan claim re-pointed
Claims processor
CLM-425818 → UHC-57021-61 (Christine Wagner)
Member id
UHC-57021-61
Confidence
1
Method
probabilistic
MBR-007869CLM-425818
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001648
Orphan claim re-pointed
Claims processor
CLM-419940 → UHC-33495-99 (Gloria Lee)
Member id
UHC-33495-99
Confidence
1
Method
probabilistic
MBR-005664CLM-419940
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001649
Orphan claim re-pointed
Claims processor
CLM-427386 → UHC-37162-88 (Mei Vasquez)
Member id
UHC-37162-88
Confidence
1
Method
probabilistic
MBR-030945CLM-427386
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001650
Orphan claim re-pointed
Claims processor
CLM-422730 → UHC-11971-67 (Benjamin Fuller)
Member id
UHC-11971-67
Confidence
1
Method
probabilistic
MBR-021063CLM-422730
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001651
Orphan claim re-pointed
Claims processor
CLM-430974 → UHC-90564-84 (Diane Olson)
Member id
UHC-90564-84
Confidence
1
Method
probabilistic
MBR-005647CLM-430974
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001652
Orphan claim re-pointed
Claims processor
CLM-402851 → UHC-16038-21 (Olivia Chapman)
Member id
UHC-16038-21
Confidence
0.97
Method
deterministic
MBR-002475CLM-402851
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001653
Orphan claim re-pointed
Claims processor
CLM-431941 → UHC-90646-41 (Diego Dominguez)
Member id
UHC-90646-41
Confidence
0.99
Method
probabilistic
MBR-026057CLM-431941
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001654
Orphan claim re-pointed
Claims processor
CLM-429681 → UHC-72843-98 (Cheryl Howell)
Member id
UHC-72843-98
Confidence
1
Method
probabilistic
MBR-001178CLM-429681
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001655
Orphan claim re-pointed
Claims processor
CLM-412884 → UHC-31359-39 (Cynthia Alvarez)
Member id
UHC-31359-39
Confidence
1
Method
probabilistic
MBR-037743CLM-412884
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001656
Orphan claim re-pointed
Claims processor
CLM-410307 → UHC-55904-11 (Helen Phillips)
Member id
UHC-55904-11
Confidence
0.97
Method
deterministic
MBR-028784CLM-410307
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001657
Orphan claim re-pointed
Claims processor
CLM-406675 → UHC-36379-12 (William Vasquez)
Member id
UHC-36379-12
Confidence
0.99
Method
probabilistic
MBR-025880CLM-406675
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001658
Orphan claim re-pointed
Claims processor
CLM-417144 → UHC-10960-04 (Anna Burke)
Member id
UHC-10960-04
Confidence
1
Method
probabilistic
MBR-018737CLM-417144
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001659
Orphan claim re-pointed
Claims processor
CLM-407266 → UHC-91645-03 (Julia George)
Member id
UHC-91645-03
Confidence
0.94
Method
probabilistic
MBR-038141CLM-407266
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001660
Orphan claim re-pointed
Claims processor
CLM-414396 → UHC-35055-55 (Santiago Miller)
Member id
UHC-35055-55
Confidence
1
Method
probabilistic
MBR-008038CLM-414396
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001661
Orphan claim re-pointed
Claims processor
CLM-404060 → UHC-71322-95 (Lauren Wong)
Member id
UHC-71322-95
Confidence
1
Method
probabilistic
MBR-002981CLM-404060
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001662
Orphan claim re-pointed
Claims processor
CLM-400475 → UHC-71028-83 (Robert Welch)
Member id
UHC-71028-83
Confidence
1
Method
probabilistic
MBR-006106CLM-400475
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001663
Orphan claim re-pointed
Claims processor
CLM-420437 → UHC-47088-25 (Ronald Ellis)
Member id
UHC-47088-25
Confidence
0.97
Method
deterministic
MBR-016763CLM-420437
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001664
Orphan claim re-pointed
Claims processor
CLM-426866 → UHC-68665-03 (Jordan Ferguson)
Member id
UHC-68665-03
Confidence
1
Method
probabilistic
MBR-018358CLM-426866
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001665
Orphan claim re-pointed
Claims processor
CLM-430822 → UHC-99271-57 (Kimberly Wang)
Member id
UHC-99271-57
Confidence
1
Method
probabilistic
MBR-028132CLM-430822
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001666
Orphan claim re-pointed
Claims processor
CLM-426923 → UHC-28733-52 (Sofia Gonzalez)
Member id
UHC-28733-52
Confidence
1
Method
probabilistic
MBR-001440CLM-426923
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001667
Orphan claim re-pointed
Claims processor
CLM-430691 → UHC-69584-36 (Jose Harvey)
Member id
UHC-69584-36
Confidence
1
Method
probabilistic
MBR-035932CLM-430691
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001668
Orphan claim re-pointed
Claims processor
CLM-401190 → UHC-19534-62 (Sofia Yang)
Member id
UHC-19534-62
Confidence
1
Method
probabilistic
MBR-007443CLM-401190
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001669
Orphan claim re-pointed
Claims processor
CLM-400995 → UHC-15801-99 (Jason Garrett)
Member id
UHC-15801-99
Confidence
1
Method
probabilistic
MBR-010493CLM-400995
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001670
Orphan claim re-pointed
Claims processor
CLM-414647 → UHC-46520-40 (Santiago Wong)
Member id
UHC-46520-40
Confidence
0.97
Method
deterministic
MBR-013102CLM-414647
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001671
Orphan claim re-pointed
Claims processor
CLM-429106 → UHC-77898-36 (Anna Murphy)
Member id
UHC-77898-36
Confidence
1
Method
probabilistic
MBR-027298CLM-429106
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001672
Orphan claim re-pointed
Claims processor
CLM-406959 → UHC-06730-30 (Joe Carlson)
Member id
UHC-06730-30
Confidence
0.97
Method
deterministic
MBR-039586CLM-406959
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001673
Orphan claim re-pointed
Claims processor
CLM-431059 → UHC-20299-86 (Jonathan Hunt)
Member id
UHC-20299-86
Confidence
1
Method
probabilistic
MBR-008072CLM-431059
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001674
Orphan claim re-pointed
Claims processor
CLM-420049 → UHC-35222-28 (Alan Pierce)
Member id
UHC-35222-28
Confidence
1
Method
probabilistic
MBR-013887CLM-420049
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001675
Orphan claim re-pointed
Claims processor
CLM-424160 → UHC-17028-42 (Randy Maldonado)
Member id
UHC-17028-42
Confidence
0.99
Method
probabilistic
MBR-019240CLM-424160
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001676
Orphan claim re-pointed
Claims processor
CLM-401783 → UHC-66150-22 (Amy Rice)
Member id
UHC-66150-22
Confidence
0.97
Method
deterministic
MBR-026347CLM-401783
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001677
Orphan claim re-pointed
Claims processor
CLM-415621 → UHC-28164-13 (Ana Walker)
Member id
UHC-28164-13
Confidence
0.97
Method
deterministic
MBR-009654CLM-415621
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001678
Orphan claim re-pointed
Claims processor
CLM-411068 → UHC-70614-01 (Beverly Ryan)
Member id
UHC-70614-01
Confidence
0.97
Method
deterministic
MBR-032871CLM-411068
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001679
Orphan claim re-pointed
Claims processor
CLM-411809 → UHC-83880-59 (Gary Hamilton)
Member id
UHC-83880-59
Confidence
1
Method
probabilistic
MBR-029620CLM-411809
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001680
Orphan claim re-pointed
Claims processor
CLM-431690 → UHC-71794-17 (Jacqueline Richards)
Member id
UHC-71794-17
Confidence
1
Method
probabilistic
MBR-002078CLM-431690
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001681
Orphan claim re-pointed
Claims processor
CLM-430466 → UHC-96542-58 (Joyce Sanders)
Member id
UHC-96542-58
Confidence
0.99
Method
probabilistic
MBR-020368CLM-430466
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001682
Orphan claim re-pointed
Claims processor
CLM-401628 → UHC-49778-27 (Cheryl Arnold)
Member id
UHC-49778-27
Confidence
1
Method
probabilistic
MBR-004892CLM-401628
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001683
Orphan claim re-pointed
Claims processor
CLM-400397 → UHC-89598-42 (Douglas Reyes)
Member id
UHC-89598-42
Confidence
1
Method
probabilistic
MBR-029149CLM-400397
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001684
Orphan claim re-pointed
Claims processor
CLM-420427 → UHC-18931-33 (Thomas Carter)
Member id
UHC-18931-33
Confidence
0.97
Method
deterministic
MBR-005273CLM-420427
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001685
Orphan claim re-pointed
Claims processor
CLM-427051 → UHC-14951-40 (Isabella Singh)
Member id
UHC-14951-40
Confidence
1
Method
probabilistic
MBR-028304CLM-427051
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001686
Orphan claim re-pointed
Claims processor
CLM-418982 → UHC-50033-62 (Gary Jordan)
Member id
UHC-50033-62
Confidence
1
Method
probabilistic
MBR-007801CLM-418982
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001687
Orphan claim re-pointed
Claims processor
CLM-431503 → UHC-12386-49 (Martha Harvey)
Member id
UHC-12386-49
Confidence
1
Method
probabilistic
MBR-004236CLM-431503
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001688
Orphan claim re-pointed
Claims processor
CLM-407638 → UHC-43455-67 (Ana Mason)
Member id
UHC-43455-67
Confidence
1
Method
probabilistic
MBR-006128CLM-407638
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001689
Orphan claim re-pointed
Claims processor
CLM-432237 → UHC-42112-04 (Carl West)
Member id
UHC-42112-04
Confidence
1
Method
probabilistic
MBR-025601CLM-432237
Executed
resolution_agent
2026-10-19 19:54:39
14,086 rows, page 7 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.