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-004790
Orphan claim re-pointed
Claims processor
CLM-430730 → UHC-27796-57 (Austin Santos)
Member id
UHC-27796-57
Confidence
1
Method
probabilistic
MBR-001096CLM-430730
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004791
Orphan claim re-pointed
Claims processor
CLM-408239 → UHC-78834-80 (Carolyn Sandoval)
Member id
UHC-78834-80
Confidence
1
Method
probabilistic
MBR-024236CLM-408239
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004792
Orphan claim re-pointed
Claims processor
CLM-402269 → UHC-83618-98 (Camila Martinez)
Member id
UHC-83618-98
Confidence
1
Method
probabilistic
MBR-032157CLM-402269
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004793
Orphan claim re-pointed
Claims processor
CLM-402062 → UHC-84370-28 (Barbara Jacobs)
Member id
UHC-84370-28
Confidence
1
Method
probabilistic
MBR-002484CLM-402062
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004794
Orphan claim re-pointed
Claims processor
CLM-429588 → UHC-00755-30 (Joan Mason)
Member id
UHC-00755-30
Confidence
1
Method
probabilistic
MBR-019530CLM-429588
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004795
Orphan claim re-pointed
Claims processor
CLM-429450 → UHC-73700-75 (Christina Garcia)
Member id
UHC-73700-75
Confidence
1.00
Method
probabilistic
MBR-025498CLM-429450
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004796
Orphan claim re-pointed
Claims processor
CLM-412213 → UHC-14032-93 (Dennis Perez)
Member id
UHC-14032-93
Confidence
1
Method
probabilistic
MBR-022525CLM-412213
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004797
Orphan claim re-pointed
Claims processor
CLM-419400 → UHC-74941-59 (Tyler Peters)
Member id
UHC-74941-59
Confidence
1
Method
probabilistic
MBR-002527CLM-419400
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004798
Orphan claim re-pointed
Claims processor
CLM-413939 → UHC-01330-32 (Albert Marshall)
Member id
UHC-01330-32
Confidence
1
Method
probabilistic
MBR-023427CLM-413939
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004799
Orphan claim re-pointed
Claims processor
CLM-418517 → UHC-37938-14 (Virginia Hudson)
Member id
UHC-37938-14
Confidence
1
Method
probabilistic
MBR-017471CLM-418517
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004800
Orphan claim re-pointed
Claims processor
CLM-429781 → UHC-42785-62 (Frances Lawson)
Member id
UHC-42785-62
Confidence
0.94
Method
probabilistic
MBR-007191CLM-429781
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004801
Orphan claim re-pointed
Claims processor
CLM-414188 → UHC-43975-35 (Dennis Castillo)
Member id
UHC-43975-35
Confidence
0.97
Method
deterministic
MBR-003705CLM-414188
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004802
Orphan claim re-pointed
Claims processor
CLM-413718 → UHC-77881-56 (Jacqueline Wagner)
Member id
UHC-77881-56
Confidence
1
Method
probabilistic
MBR-013134CLM-413718
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004803
Orphan claim re-pointed
Claims processor
CLM-407437 → UHC-88794-67 (Christopher Adams)
Member id
UHC-88794-67
Confidence
1
Method
probabilistic
MBR-026656CLM-407437
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004804
Orphan claim re-pointed
Claims processor
CLM-421509 → UHC-40709-05 (Angla Burns)
Member id
UHC-40709-05
Confidence
1
Method
probabilistic
MBR-005336CLM-421509
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004805
Orphan claim re-pointed
Claims processor
CLM-416820 → UHC-87642-81 (Diana Chen)
Member id
UHC-87642-81
Confidence
1
Method
probabilistic
MBR-001286CLM-416820
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004806
Orphan claim re-pointed
Claims processor
CLM-403610 → UHC-77954-08 (Robert Jordan)
Member id
UHC-77954-08
Confidence
0.93
Method
probabilistic
MBR-008675CLM-403610
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004807
Orphan claim re-pointed
Claims processor
CLM-406802 → UHC-22406-82 (Jacob King)
Member id
UHC-22406-82
Confidence
0.99
Method
probabilistic
MBR-001075CLM-406802
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004808
Orphan claim re-pointed
Claims processor
CLM-430490 → UHC-60974-69 (Lucia Welch)
Member id
UHC-60974-69
Confidence
1
Method
probabilistic
MBR-022786CLM-430490
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004809
Orphan claim re-pointed
Claims processor
CLM-431715 → UHC-55885-02 (Carol Lane)
Member id
UHC-55885-02
Confidence
1
Method
probabilistic
MBR-005029CLM-431715
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004810
Orphan claim re-pointed
Claims processor
CLM-427438 → UHC-79164-92 (Julie Garrett)
Member id
UHC-79164-92
Confidence
1
Method
probabilistic
MBR-022053CLM-427438
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004811
Orphan claim re-pointed
Claims processor
CLM-411538 → UHC-33371-57 (Linda Burns)
Member id
UHC-33371-57
Confidence
0.97
Method
deterministic
MBR-031869CLM-411538
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004812
Orphan claim re-pointed
Claims processor
CLM-407451 → UHC-58187-57 (Ann Sullivan)
Member id
UHC-58187-57
Confidence
1
Method
probabilistic
MBR-000819CLM-407451
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004813
Orphan claim re-pointed
Claims processor
CLM-409319 → UHC-44820-99 (Madison Graham)
Member id
UHC-44820-99
Confidence
1
Method
probabilistic
MBR-015270CLM-409319
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004814
Orphan claim re-pointed
Claims processor
CLM-417101 → UHC-28356-24 (Susan McCoy)
Member id
UHC-28356-24
Confidence
0.98
Method
probabilistic
MBR-007550CLM-417101
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004815
Orphan claim re-pointed
Claims processor
CLM-419038 → UHC-32568-63 (Becky Williams)
Member id
UHC-32568-63
Confidence
1
Method
probabilistic
MBR-001471CLM-419038
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004816
Orphan claim re-pointed
Claims processor
CLM-423580 → UHC-99113-47 (Ethan Phillips)
Member id
UHC-99113-47
Confidence
1
Method
probabilistic
MBR-012246CLM-423580
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004817
Orphan claim re-pointed
Claims processor
CLM-414353 → UHC-04909-22 (Rebecca Lewis)
Member id
UHC-04909-22
Confidence
0.97
Method
deterministic
MBR-003560CLM-414353
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004818
Orphan claim re-pointed
Claims processor
CLM-402138 → UHC-32734-85 (Bruce Johnston)
Member id
UHC-32734-85
Confidence
0.97
Method
deterministic
MBR-008126CLM-402138
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004819
Orphan claim re-pointed
Claims processor
CLM-408434 → UHC-85118-52 (Ryan Diaz)
Member id
UHC-85118-52
Confidence
1
Method
probabilistic
MBR-014971CLM-408434
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004820
Orphan claim re-pointed
Claims processor
CLM-408840 → UHC-25927-01 (Carolyn Clark)
Member id
UHC-25927-01
Confidence
1
Method
probabilistic
MBR-007377CLM-408840
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004821
Orphan claim re-pointed
Claims processor
CLM-412895 → UHC-32595-69 (Gregory Delgado)
Member id
UHC-32595-69
Confidence
1
Method
probabilistic
MBR-006263CLM-412895
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004822
Orphan claim re-pointed
Claims processor
CLM-418309 → UHC-48557-53 (Emma Berry)
Member id
UHC-48557-53
Confidence
1
Method
probabilistic
MBR-012455CLM-418309
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004823
Orphan claim re-pointed
Claims processor
CLM-414302 → UHC-10145-26 (Abigail Harrison)
Member id
UHC-10145-26
Confidence
1
Method
probabilistic
MBR-004678CLM-414302
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004824
Orphan claim re-pointed
Claims processor
CLM-402123 → UHC-38610-80 (Philip White)
Member id
UHC-38610-80
Confidence
0.97
Method
deterministic
MBR-017961CLM-402123
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004825
Orphan claim re-pointed
Claims processor
CLM-419752 → UHC-73103-71 (Theresa Garcia)
Member id
UHC-73103-71
Confidence
1
Method
probabilistic
MBR-024303CLM-419752
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004826
Orphan claim re-pointed
Claims processor
CLM-418808 → UHC-25505-58 (Tim Dean)
Member id
UHC-25505-58
Confidence
0.97
Method
deterministic
MBR-017886CLM-418808
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004827
Orphan claim re-pointed
Claims processor
CLM-421628 → UHC-17607-31 (Mei Mills)
Member id
UHC-17607-31
Confidence
0.93
Method
probabilistic
MBR-025475CLM-421628
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004828
Orphan claim re-pointed
Claims processor
CLM-415064 → UHC-10466-66 (Marilyn Jackson)
Member id
UHC-10466-66
Confidence
0.98
Method
probabilistic
MBR-018502CLM-415064
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004829
Orphan claim re-pointed
Claims processor
CLM-412903 → UHC-51193-31 (Barbara Boyd)
Member id
UHC-51193-31
Confidence
1
Method
probabilistic
MBR-010398CLM-412903
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004830
Orphan claim re-pointed
Claims processor
CLM-402945 → UHC-91801-04 (Frances Bailey)
Member id
UHC-91801-04
Confidence
1
Method
probabilistic
MBR-027271CLM-402945
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004831
Orphan claim re-pointed
Claims processor
CLM-401315 → UHC-03305-49 (Abigail Berry)
Member id
UHC-03305-49
Confidence
1
Method
probabilistic
MBR-010063CLM-401315
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004832
Orphan claim re-pointed
Claims processor
CLM-426477 → UHC-38456-67 (Gregory Day)
Member id
UHC-38456-67
Confidence
0.97
Method
deterministic
MBR-025720CLM-426477
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004833
Orphan claim re-pointed
Claims processor
CLM-421560 → UHC-03915-92 (Billy Williams)
Member id
UHC-03915-92
Confidence
1
Method
probabilistic
MBR-002302CLM-421560
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004834
Orphan claim re-pointed
Claims processor
CLM-402660 → UHC-07968-99 (Cheryl Vasquez)
Member id
UHC-07968-99
Confidence
0.97
Method
deterministic
MBR-024152CLM-402660
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004835
Orphan claim re-pointed
Claims processor
CLM-428101 → UHC-84010-93 (Valentina Cole)
Member id
UHC-84010-93
Confidence
1
Method
probabilistic
MBR-003711CLM-428101
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004836
Orphan claim re-pointed
Claims processor
CLM-405006 → UHC-92819-03 (Linda Martinez)
Member id
UHC-92819-03
Confidence
1
Method
probabilistic
MBR-034035CLM-405006
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004837
Orphan claim re-pointed
Claims processor
CLM-427920 → UHC-68920-96 (Walter Duncan)
Member id
UHC-68920-96
Confidence
1
Method
probabilistic
MBR-023178CLM-427920
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004838
Orphan claim re-pointed
Claims processor
CLM-430023 → UHC-44962-59 (Mason Santiago)
Member id
UHC-44962-59
Confidence
1
Method
probabilistic
MBR-013868CLM-430023
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004839
Orphan claim re-pointed
Claims processor
CLM-424715 → UHC-15360-01 (Daniel Jordan)
Member id
UHC-15360-01
Confidence
1
Method
probabilistic
MBR-009084CLM-424715
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 70 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.