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-004840
Orphan claim re-pointed
Claims processor
CLM-410286 → UHC-57632-09 (Daniel Alvarez)
Member id
UHC-57632-09
Confidence
1
Method
probabilistic
MBR-011255CLM-410286
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004841
Orphan claim re-pointed
Claims processor
CLM-420698 → UHC-66472-11 (Carolyn Wheeler)
Member id
UHC-66472-11
Confidence
1
Method
probabilistic
MBR-042845CLM-420698
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004842
Orphan claim re-pointed
Claims processor
CLM-418506 → UHC-20425-50 (Emma Parker)
Member id
UHC-20425-50
Confidence
0.97
Method
deterministic
MBR-002895CLM-418506
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004843
Orphan claim re-pointed
Claims processor
CLM-423931 → UHC-40678-20 (Lori Yang)
Member id
UHC-40678-20
Confidence
1
Method
probabilistic
MBR-004639CLM-423931
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004844
Orphan claim re-pointed
Claims processor
CLM-400580 → UHC-82947-39 (William Contreras)
Member id
UHC-82947-39
Confidence
0.87
Method
probabilistic
MBR-023815CLM-400580
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004845
Orphan claim re-pointed
Claims processor
CLM-424714 → UHC-15360-01 (Daniel Jordan)
Member id
UHC-15360-01
Confidence
1
Method
probabilistic
MBR-009084CLM-424714
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004846
Orphan claim re-pointed
Claims processor
CLM-402333 → UHC-92871-62 (Hannah Brooks)
Member id
UHC-92871-62
Confidence
0.97
Method
deterministic
MBR-024907CLM-402333
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004847
Orphan claim re-pointed
Claims processor
CLM-420507 → UHC-34589-55 (Judith Sanchez)
Member id
UHC-34589-55
Confidence
1
Method
probabilistic
MBR-028901CLM-420507
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004848
Orphan claim re-pointed
Claims processor
CLM-421592 → UHC-60624-22 (Bobby Castro)
Member id
UHC-60624-22
Confidence
0.99
Method
probabilistic
MBR-009179CLM-421592
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004849
Orphan claim re-pointed
Claims processor
CLM-430376 → UHC-04065-77 (Smantha Ruiz)
Member id
UHC-04065-77
Confidence
0.97
Method
deterministic
MBR-018068CLM-430376
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004850
Orphan claim re-pointed
Claims processor
CLM-415149 → UHC-56477-42 (Marcus Carr)
Member id
UHC-56477-42
Confidence
0.93
Method
probabilistic
MBR-010875CLM-415149
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004851
Orphan claim re-pointed
Claims processor
CLM-415309 → UHC-19255-33 (Brandon Rivera)
Member id
UHC-19255-33
Confidence
1
Method
probabilistic
MBR-004545CLM-415309
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004852
Orphan claim re-pointed
Claims processor
CLM-422177 → UHC-47758-36 (Austin Tucker)
Member id
UHC-47758-36
Confidence
1
Method
probabilistic
MBR-009758CLM-422177
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004853
Orphan claim re-pointed
Claims processor
CLM-422767 → UHC-91026-53 (Joe Obrien)
Member id
UHC-91026-53
Confidence
1
Method
probabilistic
MBR-006410CLM-422767
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004854
Orphan claim re-pointed
Claims processor
CLM-410330 → UHC-74277-24 (Ronald Watkins)
Member id
UHC-74277-24
Confidence
1
Method
probabilistic
MBR-011873CLM-410330
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004855
Orphan claim re-pointed
Claims processor
CLM-417952 → UHC-06317-61 (Ann Long)
Member id
UHC-06317-61
Confidence
1
Method
probabilistic
MBR-043581CLM-417952
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004856
Orphan claim re-pointed
Claims processor
CLM-422071 → UHC-73850-59 (Gerald Parker)
Member id
UHC-73850-59
Confidence
1
Method
probabilistic
MBR-002017CLM-422071
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004857
Orphan claim re-pointed
Claims processor
CLM-418316 → UHC-17288-64 (Joan Anderson)
Member id
UHC-17288-64
Confidence
1
Method
probabilistic
MBR-023128CLM-418316
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004858
Orphan claim re-pointed
Claims processor
CLM-431819 → UHC-54842-57 (Linda Munoz)
Member id
UHC-54842-57
Confidence
1
Method
probabilistic
MBR-016290CLM-431819
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004859
Orphan claim re-pointed
Claims processor
CLM-423443 → UHC-77518-93 (Stephen Payne)
Member id
UHC-77518-93
Confidence
0.93
Method
probabilistic
MBR-032993CLM-423443
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004860
Orphan claim re-pointed
Claims processor
CLM-419824 → UHC-24963-18 (Santiago Obrien)
Member id
UHC-24963-18
Confidence
0.98
Method
probabilistic
MBR-003041CLM-419824
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004861
Orphan claim re-pointed
Claims processor
CLM-412577 → UHC-43516-61 (Joe Ford)
Member id
UHC-43516-61
Confidence
1
Method
probabilistic
MBR-013387CLM-412577
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004862
Orphan claim re-pointed
Claims processor
CLM-409851 → UHC-99350-16 (Denise Stephens)
Member id
UHC-99350-16
Confidence
1
Method
probabilistic
MBR-029228CLM-409851
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004863
Orphan claim re-pointed
Claims processor
CLM-407279 → UHC-25477-01 (Nathan Singh)
Member id
UHC-25477-01
Confidence
0.97
Method
deterministic
MBR-036227CLM-407279
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004864
Orphan claim re-pointed
Claims processor
CLM-409390 → UHC-56406-57 (Jonathan Gardner)
Member id
UHC-56406-57
Confidence
1
Method
probabilistic
MBR-004328CLM-409390
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004865
Orphan claim re-pointed
Claims processor
CLM-416095 → UHC-12370-45 (Sandra Mason)
Member id
UHC-12370-45
Confidence
1
Method
probabilistic
MBR-000494CLM-416095
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004866
Orphan claim re-pointed
Claims processor
CLM-431166 → UHC-25672-92 (Elizabeth Myers)
Member id
UHC-25672-92
Confidence
0.97
Method
deterministic
MBR-009176CLM-431166
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004867
Orphan claim re-pointed
Claims processor
CLM-402607 → UHC-70632-75 (Gerald Howell)
Member id
UHC-70632-75
Confidence
0.93
Method
probabilistic
MBR-038663CLM-402607
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004868
Orphan claim re-pointed
Claims processor
CLM-413749 → UHC-93422-08 (Gregory Mendez)
Member id
UHC-93422-08
Confidence
1
Method
probabilistic
MBR-030510CLM-413749
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004869
Orphan claim re-pointed
Claims processor
CLM-412648 → UHC-69097-81 (Janet Young)
Member id
UHC-69097-81
Confidence
1
Method
probabilistic
MBR-006630CLM-412648
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004870
Orphan claim re-pointed
Claims processor
CLM-426660 → UHC-67515-75 (Debra Lee)
Member id
UHC-67515-75
Confidence
1
Method
probabilistic
MBR-022321CLM-426660
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004871
Orphan claim re-pointed
Claims processor
CLM-414087 → UHC-63894-92 (Tyler Adams)
Member id
UHC-63894-92
Confidence
1
Method
probabilistic
MBR-009269CLM-414087
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004872
Orphan claim re-pointed
Claims processor
CLM-422632 → UHC-13473-34 (Heather Hudson)
Member id
UHC-13473-34
Confidence
1
Method
probabilistic
MBR-022411CLM-422632
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004873
Orphan claim re-pointed
Claims processor
CLM-409902 → UHC-70834-58 (Kevin Coleman)
Member id
UHC-70834-58
Confidence
1
Method
probabilistic
MBR-035647CLM-409902
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004874
Orphan claim re-pointed
Claims processor
CLM-417338 → UHC-14545-99 (Jerry Ramos)
Member id
UHC-14545-99
Confidence
0.99
Method
probabilistic
MBR-011707CLM-417338
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004875
Orphan claim re-pointed
Claims processor
CLM-405690 → UHC-73022-03 (Ruth Hanson)
Member id
UHC-73022-03
Confidence
1
Method
probabilistic
MBR-017141CLM-405690
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004876
Orphan claim re-pointed
Claims processor
CLM-420948 → UHC-52531-44 (Jason Murray)
Member id
UHC-52531-44
Confidence
1
Method
probabilistic
MBR-031042CLM-420948
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004877
Orphan claim re-pointed
Claims processor
CLM-403224 → UHC-94863-84 (Michael Campbell)
Member id
UHC-94863-84
Confidence
1
Method
probabilistic
MBR-013984CLM-403224
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004878
Orphan claim re-pointed
Claims processor
CLM-415128 → UHC-47059-01 (Natalie Henry)
Member id
UHC-47059-01
Confidence
1
Method
probabilistic
MBR-022809CLM-415128
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004879
Orphan claim re-pointed
Claims processor
CLM-412651 → UHC-37643-23 (Evelyn Stewart)
Member id
UHC-37643-23
Confidence
1
Method
probabilistic
MBR-008257CLM-412651
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004880
Orphan claim re-pointed
Claims processor
CLM-409668 → UHC-50547-71 (Barb Hansen)
Member id
UHC-50547-71
Confidence
1
Method
probabilistic
MBR-005050CLM-409668
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004881
Orphan claim re-pointed
Claims processor
CLM-422428 → UHC-60111-01 (Doris Frod)
Member id
UHC-60111-01
Confidence
0.98
Method
probabilistic
MBR-023725CLM-422428
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004882
Orphan claim re-pointed
Claims processor
CLM-431397 → UHC-69637-54 (Jesse Stewart)
Member id
UHC-69637-54
Confidence
0.89
Method
probabilistic
MBR-011341CLM-431397
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004883
Orphan claim re-pointed
Claims processor
CLM-420132 → UHC-58560-58 (Lawrence Butler)
Member id
UHC-58560-58
Confidence
1
Method
probabilistic
MBR-006792CLM-420132
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004884
Orphan claim re-pointed
Claims processor
CLM-423846 → UHC-35977-69 (Anna Wong)
Member id
UHC-35977-69
Confidence
0.94
Method
probabilistic
MBR-026522CLM-423846
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004885
Orphan claim re-pointed
Claims processor
CLM-410649 → UHC-75411-44 (Hiroshi Lynch)
Member id
UHC-75411-44
Confidence
1
Method
probabilistic
MBR-030605CLM-410649
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004886
Orphan claim re-pointed
Claims processor
CLM-430618 → UHC-38405-46 (Peter Burton)
Member id
UHC-38405-46
Confidence
0.99
Method
probabilistic
MBR-031375CLM-430618
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004887
Orphan claim re-pointed
Claims processor
CLM-421841 → UHC-79864-92 (Philip Owens)
Member id
UHC-79864-92
Confidence
1
Method
probabilistic
MBR-017216CLM-421841
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004888
Orphan claim re-pointed
Claims processor
CLM-412320 → UHC-51105-44 (Diana Porter)
Member id
UHC-51105-44
Confidence
0.97
Method
deterministic
MBR-043405CLM-412320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-004889
Orphan claim re-pointed
Claims processor
CLM-428208 → UHC-11771-53 (Abby Murray)
Member id
UHC-11771-53
Confidence
1
Method
probabilistic
MBR-021972CLM-428208
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 71 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.