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-005240
Orphan claim re-pointed
Claims processor
CLM-412165 → UHC-12094-80 (Nancy Burton)
Member id
UHC-12094-80
Confidence
1
Method
probabilistic
MBR-044511CLM-412165
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005241
Orphan claim re-pointed
Claims processor
CLM-431218 → UHC-50579-26 (Amanda Rice)
Member id
UHC-50579-26
Confidence
0.97
Method
deterministic
MBR-000512CLM-431218
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005242
Orphan claim re-pointed
Claims processor
CLM-416410 → UHC-16604-78 (Amber Bryant)
Member id
UHC-16604-78
Confidence
0.97
Method
deterministic
MBR-003257CLM-416410
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005243
Orphan claim re-pointed
Claims processor
CLM-420670 → UHC-10822-60 (Nathan Murray)
Member id
UHC-10822-60
Confidence
1
Method
probabilistic
MBR-021573CLM-420670
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005244
Orphan claim re-pointed
Claims processor
CLM-421891 → UHC-11506-03 (Camila Wang)
Member id
UHC-11506-03
Confidence
1
Method
probabilistic
MBR-002042CLM-421891
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005245
Orphan claim re-pointed
Claims processor
CLM-427731 → UHC-84064-26 (Mateo Singh)
Member id
UHC-84064-26
Confidence
0.97
Method
deterministic
MBR-044214CLM-427731
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005246
Orphan claim re-pointed
Claims processor
CLM-421120 → UHC-85610-69 (Evelyn Maldonado)
Member id
UHC-85610-69
Confidence
1
Method
probabilistic
MBR-021644CLM-421120
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005247
Orphan claim re-pointed
Claims processor
CLM-422489 → UHC-55634-10 (Paul Vazquez)
Member id
UHC-55634-10
Confidence
1
Method
probabilistic
MBR-029318CLM-422489
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005248
Orphan claim re-pointed
Claims processor
CLM-430315 → UHC-74911-42 (Ethan Weber)
Member id
UHC-74911-42
Confidence
1
Method
probabilistic
MBR-003393CLM-430315
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005249
Orphan claim re-pointed
Claims processor
CLM-411594 → UHC-89738-84 (Amanda Allen)
Member id
UHC-89738-84
Confidence
0.98
Method
probabilistic
MBR-011240CLM-411594
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005250
Orphan claim re-pointed
Claims processor
CLM-410449 → UHC-64090-94 (Diane Burke)
Member id
UHC-64090-94
Confidence
1
Method
probabilistic
MBR-025580CLM-410449
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005251
Orphan claim re-pointed
Claims processor
CLM-424285 → UHC-06107-12 (Aisha Walker)
Member id
UHC-06107-12
Confidence
1
Method
probabilistic
MBR-011245CLM-424285
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005252
Orphan claim re-pointed
Claims processor
CLM-419180 → UHC-27461-26 (Elijah Munoz)
Member id
UHC-27461-26
Confidence
1
Method
probabilistic
MBR-016901CLM-419180
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005253
Orphan claim re-pointed
Claims processor
CLM-405218 → UHC-80110-73 (Carol Davis)
Member id
UHC-80110-73
Confidence
1
Method
probabilistic
MBR-026802CLM-405218
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005254
Orphan claim re-pointed
Claims processor
CLM-415770 → UHC-71756-75 (Tyler Moore)
Member id
UHC-71756-75
Confidence
1
Method
probabilistic
MBR-011325CLM-415770
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005255
Orphan claim re-pointed
Claims processor
CLM-400876 → UHC-70193-72 (Karen Le)
Member id
UHC-70193-72
Confidence
0.99
Method
probabilistic
MBR-030862CLM-400876
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005256
Orphan claim re-pointed
Claims processor
CLM-427523 → UHC-84824-01 (Judith Guzman)
Member id
UHC-84824-01
Confidence
0.93
Method
probabilistic
MBR-024024CLM-427523
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005257
Orphan claim re-pointed
Claims processor
CLM-408316 → UHC-49084-09 (Susan Estrada)
Member id
UHC-49084-09
Confidence
0.97
Method
deterministic
MBR-043076CLM-408316
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005258
Orphan claim re-pointed
Claims processor
CLM-421498 → UHC-42424-16 (William Kim)
Member id
UHC-42424-16
Confidence
1
Method
probabilistic
MBR-026527CLM-421498
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005259
Orphan claim re-pointed
Claims processor
CLM-410320 → UHC-79386-51 (Mark Evans)
Member id
UHC-79386-51
Confidence
1
Method
probabilistic
MBR-040894CLM-410320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005260
Orphan claim re-pointed
Claims processor
CLM-416520 → UHC-56603-65 (Matthew Li)
Member id
UHC-56603-65
Confidence
0.97
Method
deterministic
MBR-004681CLM-416520
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005261
Orphan claim re-pointed
Claims processor
CLM-421852 → UHC-38780-55 (Eric Watson)
Member id
UHC-38780-55
Confidence
1
Method
probabilistic
MBR-020258CLM-421852
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005262
Orphan claim re-pointed
Claims processor
CLM-428743 → UHC-54310-48 (Sharon Luna)
Member id
UHC-54310-48
Confidence
1
Method
probabilistic
MBR-025673CLM-428743
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005263
Orphan claim re-pointed
Claims processor
CLM-405769 → UHC-82443-76 (Austin Riley)
Member id
UHC-82443-76
Confidence
1
Method
probabilistic
MBR-014595CLM-405769
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005264
Orphan claim re-pointed
Claims processor
CLM-417610 → UHC-13382-61 (Maria Perkins)
Member id
UHC-13382-61
Confidence
1
Method
probabilistic
MBR-019478CLM-417610
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005265
Orphan claim re-pointed
Claims processor
CLM-413659 → UHC-54331-87 (Timothy Dixon)
Member id
UHC-54331-87
Confidence
1
Method
probabilistic
MBR-015077CLM-413659
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005266
Orphan claim re-pointed
Claims processor
CLM-422586 → UHC-87605-29 (Charles Boyd)
Member id
UHC-87605-29
Confidence
0.99
Method
probabilistic
MBR-009490CLM-422586
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005267
Orphan claim re-pointed
Claims processor
CLM-411483 → UHC-01154-91 (Valentina Marquez)
Member id
UHC-01154-91
Confidence
0.97
Method
deterministic
MBR-002553CLM-411483
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005268
Orphan claim re-pointed
Claims processor
CLM-407016 → UHC-22573-16 (Daniel Ryan)
Member id
UHC-22573-16
Confidence
0.97
Method
deterministic
MBR-029025CLM-407016
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005269
Orphan claim re-pointed
Claims processor
CLM-405647 → UHC-12381-44 (Jordan Wallace)
Member id
UHC-12381-44
Confidence
1
Method
probabilistic
MBR-030577CLM-405647
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005270
Orphan claim re-pointed
Claims processor
CLM-414516 → UHC-95289-30 (Kimberly Cooper)
Member id
UHC-95289-30
Confidence
1
Method
probabilistic
MBR-021961CLM-414516
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005271
Orphan claim re-pointed
Claims processor
CLM-406094 → UHC-35139-26 (Amber Valdez)
Member id
UHC-35139-26
Confidence
1
Method
probabilistic
MBR-014998CLM-406094
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005272
Orphan claim re-pointed
Claims processor
CLM-412528 → UHC-53297-26 (Jon Parker)
Member id
UHC-53297-26
Confidence
1
Method
probabilistic
MBR-000908CLM-412528
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005273
Orphan claim re-pointed
Claims processor
CLM-414372 → UHC-40970-34 (Brian Lynch)
Member id
UHC-40970-34
Confidence
0.97
Method
deterministic
MBR-020957CLM-414372
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005274
Orphan claim re-pointed
Claims processor
CLM-413426 → UHC-44275-91 (Elizabeth Nichols)
Member id
UHC-44275-91
Confidence
1
Method
probabilistic
MBR-019977CLM-413426
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005275
Orphan claim re-pointed
Claims processor
CLM-421801 → UHC-68587-26 (Harold Morales)
Member id
UHC-68587-26
Confidence
1
Method
probabilistic
MBR-022771CLM-421801
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005276
Orphan claim re-pointed
Claims processor
CLM-413352 → UHC-87150-10 (Sarah Kennedy)
Member id
UHC-87150-10
Confidence
1
Method
probabilistic
MBR-014518CLM-413352
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005277
Orphan claim re-pointed
Claims processor
CLM-426067 → UHC-84217-49 (Alexander Marquez)
Member id
UHC-84217-49
Confidence
1
Method
probabilistic
MBR-022090CLM-426067
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005278
Orphan claim re-pointed
Claims processor
CLM-402814 → UHC-52239-76 (Brandon Obrien)
Member id
UHC-52239-76
Confidence
1
Method
probabilistic
MBR-004931CLM-402814
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005279
Orphan claim re-pointed
Claims processor
CLM-424631 → UHC-38096-98 (Stephen Soto)
Member id
UHC-38096-98
Confidence
1
Method
probabilistic
MBR-019042CLM-424631
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005280
Orphan claim re-pointed
Claims processor
CLM-419999 → UHC-95158-61 (Steven Turner)
Member id
UHC-95158-61
Confidence
0.99
Method
probabilistic
MBR-007554CLM-419999
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005281
Orphan claim re-pointed
Claims processor
CLM-403549 → UHC-39760-46 (Carolyn Jackson)
Member id
UHC-39760-46
Confidence
1
Method
probabilistic
MBR-012381CLM-403549
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005282
Orphan claim re-pointed
Claims processor
CLM-432037 → UHC-17259-22 (Jack Spencer)
Member id
UHC-17259-22
Confidence
0.85
Method
probabilistic
MBR-004037CLM-432037
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005283
Orphan claim re-pointed
Claims processor
CLM-401292 → UHC-32322-15 (Christopher Coleman)
Member id
UHC-32322-15
Confidence
0.99
Method
probabilistic
MBR-026219CLM-401292
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005284
Orphan claim re-pointed
Claims processor
CLM-428739 → UHC-21212-69 (Carl Li)
Member id
UHC-21212-69
Confidence
1
Method
probabilistic
MBR-012634CLM-428739
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005285
Orphan claim re-pointed
Claims processor
CLM-431074 → UHC-00720-73 (Brenda Carpenter)
Member id
UHC-00720-73
Confidence
1
Method
probabilistic
MBR-025314CLM-431074
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005286
Orphan claim re-pointed
Claims processor
CLM-422397 → UHC-60575-35 (Betty Rilley)
Member id
UHC-60575-35
Confidence
0.92
Method
probabilistic
MBR-033279CLM-422397
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005287
Orphan claim re-pointed
Claims processor
CLM-416984 → UHC-34661-92 (Walter Washington)
Member id
UHC-34661-92
Confidence
1
Method
probabilistic
MBR-007842CLM-416984
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005288
Orphan claim re-pointed
Claims processor
CLM-404793 → UHC-96131-84 (Patrick Spencer)
Member id
UHC-96131-84
Confidence
1
Method
probabilistic
MBR-032086CLM-404793
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005289
Orphan claim re-pointed
Claims processor
CLM-420660 → UHC-30457-37 (Melissa Hansen)
Member id
UHC-30457-37
Confidence
1
Method
probabilistic
MBR-001994CLM-420660
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 79 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.