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-005090
Orphan claim re-pointed
Claims processor
CLM-418828 → UHC-79922-12 (Natalie Tran)
Member id
UHC-79922-12
Confidence
1
Method
probabilistic
MBR-001211CLM-418828
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005091
Orphan claim re-pointed
Claims processor
CLM-415967 → UHC-98759-52 (Charles Murphy)
Member id
UHC-98759-52
Confidence
1
Method
probabilistic
MBR-000466CLM-415967
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005092
Orphan claim re-pointed
Claims processor
CLM-423081 → UHC-88779-51 (Kenneth Nguyen)
Member id
UHC-88779-51
Confidence
0.97
Method
deterministic
MBR-009224CLM-423081
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005093
Orphan claim re-pointed
Claims processor
CLM-410794 → UHC-42995-87 (Terry Gardner)
Member id
UHC-42995-87
Confidence
1
Method
probabilistic
MBR-033643CLM-410794
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005094
Orphan claim re-pointed
Claims processor
CLM-411232 → UHC-89373-58 (Camila Turner)
Member id
UHC-89373-58
Confidence
1
Method
probabilistic
MBR-033209CLM-411232
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005095
Orphan claim re-pointed
Claims processor
CLM-412944 → UHC-05703-45 (Gloria Allen)
Member id
UHC-05703-45
Confidence
0.97
Method
deterministic
MBR-025233CLM-412944
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005096
Orphan claim re-pointed
Claims processor
CLM-415675 → UHC-00963-84 (Charlotte Le)
Member id
UHC-00963-84
Confidence
0.97
Method
deterministic
MBR-020498CLM-415675
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005097
Orphan claim re-pointed
Claims processor
CLM-411604 → UHC-87151-33 (Noah Burton)
Member id
UHC-87151-33
Confidence
0.99
Method
probabilistic
MBR-026770CLM-411604
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005098
Orphan claim re-pointed
Claims processor
CLM-429807 → UHC-73352-65 (Jessica Hunt)
Member id
UHC-73352-65
Confidence
0.97
Method
deterministic
MBR-005286CLM-429807
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005099
Orphan claim re-pointed
Claims processor
CLM-430871 → UHC-41463-71 (Cheryl Chavez)
Member id
UHC-41463-71
Confidence
1
Method
probabilistic
MBR-018078CLM-430871
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005100
Orphan claim re-pointed
Claims processor
CLM-421384 → UHC-73381-77 (Noah Cook)
Member id
UHC-73381-77
Confidence
0.98
Method
probabilistic
MBR-021580CLM-421384
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005101
Orphan claim re-pointed
Claims processor
CLM-417544 → UHC-51984-99 (Sandra Hart)
Member id
UHC-51984-99
Confidence
1
Method
probabilistic
MBR-008167CLM-417544
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005102
Orphan claim re-pointed
Claims processor
CLM-406784 → UHC-94097-91 (Robert Dunn)
Member id
UHC-94097-91
Confidence
0.94
Method
probabilistic
MBR-017810CLM-406784
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005103
Orphan claim re-pointed
Claims processor
CLM-418407 → UHC-72907-79 (Sharon Greene)
Member id
UHC-72907-79
Confidence
0.97
Method
deterministic
MBR-016102CLM-418407
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005104
Orphan claim re-pointed
Claims processor
CLM-431366 → UHC-36200-07 (Heather Reid)
Member id
UHC-36200-07
Confidence
1
Method
probabilistic
MBR-019600CLM-431366
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005105
Orphan claim re-pointed
Claims processor
CLM-400983 → UHC-71942-05 (David Moreno)
Member id
UHC-71942-05
Confidence
1
Method
probabilistic
MBR-026591CLM-400983
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005106
Orphan claim re-pointed
Claims processor
CLM-403993 → UHC-88797-59 (Mark Hudson)
Member id
UHC-88797-59
Confidence
1
Method
probabilistic
MBR-005027CLM-403993
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005107
Orphan claim re-pointed
Claims processor
CLM-416535 → UHC-49692-58 (Yuki Ward)
Member id
UHC-49692-58
Confidence
1
Method
probabilistic
MBR-011223CLM-416535
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005108
Orphan claim re-pointed
Claims processor
CLM-416089 → UHC-44982-76 (Jennifer Kellye)
Member id
UHC-44982-76
Confidence
0.99
Method
probabilistic
MBR-006914CLM-416089
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005109
Orphan claim re-pointed
Claims processor
CLM-402426 → UHC-30142-52 (James Chen)
Member id
UHC-30142-52
Confidence
1
Method
probabilistic
MBR-004961CLM-402426
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005110
Orphan claim re-pointed
Claims processor
CLM-418330 → UHC-79140-14 (Brittany Jensen)
Member id
UHC-79140-14
Confidence
0.97
Method
deterministic
MBR-026893CLM-418330
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005111
Orphan claim re-pointed
Claims processor
CLM-413902 → UHC-07622-05 (Justin Johnson)
Member id
UHC-07622-05
Confidence
0.99
Method
probabilistic
MBR-034053CLM-413902
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005112
Orphan claim re-pointed
Claims processor
CLM-407856 → UHC-88715-46 (Ronald Espinoza)
Member id
UHC-88715-46
Confidence
1
Method
probabilistic
MBR-002670CLM-407856
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005113
Orphan claim re-pointed
Claims processor
CLM-407608 → UHC-88336-76 (Richard Washington)
Member id
UHC-88336-76
Confidence
1.00
Method
probabilistic
MBR-034353CLM-407608
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005114
Orphan claim re-pointed
Claims processor
CLM-412772 → UHC-31938-22 (Henry Alexander)
Member id
UHC-31938-22
Confidence
1
Method
probabilistic
MBR-038139CLM-412772
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005115
Orphan claim re-pointed
Claims processor
CLM-417691 → UHC-22861-85 (Sophia Martinez)
Member id
UHC-22861-85
Confidence
1
Method
probabilistic
MBR-021022CLM-417691
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005116
Orphan claim re-pointed
Claims processor
CLM-428201 → UHC-45914-08 (George Herrera)
Member id
UHC-45914-08
Confidence
1.00
Method
probabilistic
MBR-000030CLM-428201
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005117
Orphan claim re-pointed
Claims processor
CLM-409085 → UHC-61419-84 (Kathryn Knight)
Member id
UHC-61419-84
Confidence
1
Method
probabilistic
MBR-013145CLM-409085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005118
Orphan claim re-pointed
Claims processor
CLM-420893 → UHC-34115-12 (Benjamin Collins)
Member id
UHC-34115-12
Confidence
1
Method
probabilistic
MBR-013132CLM-420893
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005119
Orphan claim re-pointed
Claims processor
CLM-401457 → UHC-82145-43 (Teresa Hill)
Member id
UHC-82145-43
Confidence
1
Method
probabilistic
MBR-012047CLM-401457
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005120
Orphan claim re-pointed
Claims processor
CLM-415634 → UHC-39770-46 (Amanda Reed)
Member id
UHC-39770-46
Confidence
0.97
Method
deterministic
MBR-012752CLM-415634
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005121
Orphan claim re-pointed
Claims processor
CLM-404643 → UHC-30998-65 (Sean Torres)
Member id
UHC-30998-65
Confidence
1
Method
probabilistic
MBR-032583CLM-404643
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005122
Orphan claim re-pointed
Claims processor
CLM-406201 → UHC-35361-14 (Kathryn Sanchez)
Member id
UHC-35361-14
Confidence
0.99
Method
probabilistic
MBR-037746CLM-406201
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005123
Orphan claim re-pointed
Claims processor
CLM-404276 → UHC-66259-56 (Virginia Ross)
Member id
UHC-66259-56
Confidence
1
Method
probabilistic
MBR-042450CLM-404276
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005124
Orphan claim re-pointed
Claims processor
CLM-426697 → UHC-39362-82 (Dennis Harris)
Member id
UHC-39362-82
Confidence
1
Method
probabilistic
MBR-016293CLM-426697
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005125
Orphan claim re-pointed
Claims processor
CLM-402109 → UHC-15907-13 (Emily Adams)
Member id
UHC-15907-13
Confidence
1
Method
probabilistic
MBR-045200CLM-402109
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005126
Orphan claim re-pointed
Claims processor
CLM-411719 → UHC-72502-21 (Elijah Jones)
Member id
UHC-72502-21
Confidence
0.97
Method
deterministic
MBR-003856CLM-411719
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005127
Orphan claim re-pointed
Claims processor
CLM-424740 → UHC-10537-45 (Santiago Peterson)
Member id
UHC-10537-45
Confidence
1
Method
probabilistic
MBR-022962CLM-424740
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005128
Orphan claim re-pointed
Claims processor
CLM-414150 → UHC-07842-57 (Ralph Cole)
Member id
UHC-07842-57
Confidence
1
Method
probabilistic
MBR-017110CLM-414150
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005129
Orphan claim re-pointed
Claims processor
CLM-415922 → UHC-89293-82 (Marcus Alexander)
Member id
UHC-89293-82
Confidence
1
Method
probabilistic
MBR-015044CLM-415922
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005130
Orphan claim re-pointed
Claims processor
CLM-428112 → UHC-75946-86 (Janice Mills)
Member id
UHC-75946-86
Confidence
1
Method
probabilistic
MBR-019283CLM-428112
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005131
Orphan claim re-pointed
Claims processor
CLM-422569 → UHC-58555-26 (Barbara Vasquez)
Member id
UHC-58555-26
Confidence
1
Method
probabilistic
MBR-015437CLM-422569
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005132
Orphan claim re-pointed
Claims processor
CLM-420799 → UHC-37202-97 (Carlos Maldonado)
Member id
UHC-37202-97
Confidence
0.97
Method
deterministic
MBR-018365CLM-420799
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005133
Orphan claim re-pointed
Claims processor
CLM-421980 → UHC-10502-17 (Grace Stephens)
Member id
UHC-10502-17
Confidence
1
Method
probabilistic
MBR-002522CLM-421980
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005134
Orphan claim re-pointed
Claims processor
CLM-418965 → UHC-23580-88 (Wei Greene)
Member id
UHC-23580-88
Confidence
0.93
Method
probabilistic
MBR-001761CLM-418965
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005135
Orphan claim re-pointed
Claims processor
CLM-413480 → UHC-29432-01 (Carol Gonzalez)
Member id
UHC-29432-01
Confidence
1
Method
probabilistic
MBR-010914CLM-413480
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005136
Orphan claim re-pointed
Claims processor
CLM-427530 → UHC-01760-71 (Elijah Lane)
Member id
UHC-01760-71
Confidence
0.97
Method
deterministic
MBR-025406CLM-427530
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005137
Orphan claim re-pointed
Claims processor
CLM-419547 → UHC-87606-64 (Vicky Howard)
Member id
UHC-87606-64
Confidence
1.00
Method
probabilistic
MBR-010933CLM-419547
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005138
Orphan claim re-pointed
Claims processor
CLM-418979 → UHC-27686-30 (Mei Singh)
Member id
UHC-27686-30
Confidence
0.97
Method
deterministic
MBR-030559CLM-418979
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005139
Orphan claim re-pointed
Claims processor
CLM-414482 → UHC-36583-04 (Joan Torres)
Member id
UHC-36583-04
Confidence
1
Method
probabilistic
MBR-006817CLM-414482
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 76 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.