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-001690
Orphan claim re-pointed
Claims processor
CLM-431801 → UHC-68365-96 (Ann Alvarado)
Member id
UHC-68365-96
Confidence
1
Method
probabilistic
MBR-023244CLM-431801
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001691
Orphan claim re-pointed
Claims processor
CLM-410388 → UHC-20902-98 (Jeremy Cook)
Member id
UHC-20902-98
Confidence
0.97
Method
deterministic
MBR-012010CLM-410388
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001692
Orphan claim re-pointed
Claims processor
CLM-424061 → UHC-10104-58 (Luis Jones)
Member id
UHC-10104-58
Confidence
0.97
Method
deterministic
MBR-022603CLM-424061
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001693
Orphan claim re-pointed
Claims processor
CLM-413004 → UHC-54709-71 (Mateo Barnes)
Member id
UHC-54709-71
Confidence
1
Method
probabilistic
MBR-012219CLM-413004
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001694
Orphan claim re-pointed
Claims processor
CLM-427949 → UHC-54097-94 (Lauren Howard)
Member id
UHC-54097-94
Confidence
1
Method
probabilistic
MBR-031234CLM-427949
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001695
Orphan claim re-pointed
Claims processor
CLM-429625 → UHC-46672-95 (Sue Williams)
Member id
UHC-46672-95
Confidence
0.97
Method
deterministic
MBR-002070CLM-429625
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001696
Orphan claim re-pointed
Claims processor
CLM-427534 → UHC-81174-40 (Christian Meyer)
Member id
UHC-81174-40
Confidence
1
Method
probabilistic
MBR-008776CLM-427534
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001697
Orphan claim re-pointed
Claims processor
CLM-410267 → UHC-53781-65 (Michael Evans)
Member id
UHC-53781-65
Confidence
0.97
Method
deterministic
MBR-031146CLM-410267
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001698
Orphan claim re-pointed
Claims processor
CLM-424532 → UHC-44026-65 (Bryan Hanson)
Member id
UHC-44026-65
Confidence
1
Method
probabilistic
MBR-011504CLM-424532
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001699
Orphan claim re-pointed
Claims processor
CLM-409805 → UHC-36731-44 (Dennis Greene)
Member id
UHC-36731-44
Confidence
1
Method
probabilistic
MBR-030963CLM-409805
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001700
Orphan claim re-pointed
Claims processor
CLM-429840 → UHC-94950-75 (Lauren Ramos)
Member id
UHC-94950-75
Confidence
1
Method
probabilistic
MBR-040551CLM-429840
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001701
Orphan claim re-pointed
Claims processor
CLM-424103 → UHC-36356-27 (Edward George)
Member id
UHC-36356-27
Confidence
0.97
Method
deterministic
MBR-004829CLM-424103
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001702
Orphan claim re-pointed
Claims processor
CLM-415835 → UHC-98476-18 (Kenneth Thompson)
Member id
UHC-98476-18
Confidence
1
Method
probabilistic
MBR-023075CLM-415835
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001703
Orphan claim re-pointed
Claims processor
CLM-408785 → UHC-27250-83 (Santiago Moore)
Member id
UHC-27250-83
Confidence
1
Method
probabilistic
MBR-014232CLM-408785
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001704
Orphan claim re-pointed
Claims processor
CLM-410955 → UHC-53705-72 (Noah Roberts)
Member id
UHC-53705-72
Confidence
1
Method
probabilistic
MBR-016768CLM-410955
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001705
Orphan claim re-pointed
Claims processor
CLM-418555 → UHC-31222-94 (Sara Owens)
Member id
UHC-31222-94
Confidence
1
Method
probabilistic
MBR-002276CLM-418555
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001706
Orphan claim re-pointed
Claims processor
CLM-405959 → UHC-16884-13 (David Padilla)
Member id
UHC-16884-13
Confidence
1
Method
probabilistic
MBR-013557CLM-405959
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001707
Orphan claim re-pointed
Claims processor
CLM-411066 → UHC-28897-69 (Sandra Morgan)
Member id
UHC-28897-69
Confidence
1
Method
probabilistic
MBR-023034CLM-411066
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001708
Orphan claim re-pointed
Claims processor
CLM-401734 → UHC-27338-25 (Kyle Schultz)
Member id
UHC-27338-25
Confidence
0.93
Method
probabilistic
MBR-038855CLM-401734
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001709
Orphan claim re-pointed
Claims processor
CLM-423214 → UHC-27580-31 (Ana Nunez)
Member id
UHC-27580-31
Confidence
1
Method
probabilistic
MBR-000901CLM-423214
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001710
Orphan claim re-pointed
Claims processor
CLM-409816 → UHC-52639-41 (Hiroshi Rice)
Member id
UHC-52639-41
Confidence
0.97
Method
deterministic
MBR-004166CLM-409816
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001711
Orphan claim re-pointed
Claims processor
CLM-411558 → UHC-19513-90 (Gary King)
Member id
UHC-19513-90
Confidence
1
Method
probabilistic
MBR-017229CLM-411558
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001712
Orphan claim re-pointed
Claims processor
CLM-406752 → UHC-39058-94 (Maria Robinson)
Member id
UHC-39058-94
Confidence
1
Method
probabilistic
MBR-000118CLM-406752
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001713
Orphan claim re-pointed
Claims processor
CLM-430724 → UHC-62782-53 (Mateo Salazar)
Member id
UHC-62782-53
Confidence
1
Method
probabilistic
MBR-004679CLM-430724
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001714
Orphan claim re-pointed
Claims processor
CLM-412820 → UHC-85614-59 (Hiroshi Harvey)
Member id
UHC-85614-59
Confidence
0.94
Method
probabilistic
MBR-017002CLM-412820
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001715
Orphan claim re-pointed
Claims processor
CLM-429986 → UHC-06749-57 (Raymond Wood)
Member id
UHC-06749-57
Confidence
0.97
Method
deterministic
MBR-009283CLM-429986
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001716
Orphan claim re-pointed
Claims processor
CLM-402368 → UHC-43478-17 (Charles Singh)
Member id
UHC-43478-17
Confidence
0.86
Method
probabilistic
MBR-026416CLM-402368
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001717
Orphan claim re-pointed
Claims processor
CLM-428852 → UHC-57396-21 (Deborah Richards)
Member id
UHC-57396-21
Confidence
1
Method
probabilistic
MBR-035327CLM-428852
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001718
Orphan claim re-pointed
Claims processor
CLM-422357 → UHC-60709-46 (Bruce Bradley)
Member id
UHC-60709-46
Confidence
1
Method
probabilistic
MBR-014558CLM-422357
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001719
Orphan claim re-pointed
Claims processor
CLM-432226 → UHC-99920-82 (Nicole Coleman)
Member id
UHC-99920-82
Confidence
1
Method
probabilistic
MBR-019483CLM-432226
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001720
Orphan claim re-pointed
Claims processor
CLM-409300 → UHC-88385-96 (Raymond Campbell)
Member id
UHC-88385-96
Confidence
1
Method
probabilistic
MBR-001607CLM-409300
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001721
Orphan claim re-pointed
Claims processor
CLM-417721 → UHC-73218-61 (Joseph Wheeler)
Member id
UHC-73218-61
Confidence
1
Method
probabilistic
MBR-027694CLM-417721
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001722
Orphan claim re-pointed
Claims processor
CLM-402366 → UHC-92649-44 (Roger Crawford)
Member id
UHC-92649-44
Confidence
0.99
Method
probabilistic
MBR-000491CLM-402366
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001723
Orphan claim re-pointed
Claims processor
CLM-424832 → UHC-65868-91 (Joe Weaver)
Member id
UHC-65868-91
Confidence
1
Method
probabilistic
MBR-008077CLM-424832
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001724
Orphan claim re-pointed
Claims processor
CLM-407598 → UHC-74481-70 (Beverly Phillips)
Member id
UHC-74481-70
Confidence
1
Method
probabilistic
MBR-006005CLM-407598
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001725
Orphan claim re-pointed
Claims processor
CLM-414802 → UHC-71698-36 (John Lynch)
Member id
UHC-71698-36
Confidence
1
Method
probabilistic
MBR-022288CLM-414802
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001726
Orphan claim re-pointed
Claims processor
CLM-416689 → UHC-57264-54 (Heatheer George)
Member id
UHC-57264-54
Confidence
0.99
Method
probabilistic
MBR-037750CLM-416689
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001727
Orphan claim re-pointed
Claims processor
CLM-428585 → UHC-76545-20 (Wayne Dunn)
Member id
UHC-76545-20
Confidence
0.99
Method
probabilistic
MBR-039232CLM-428585
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001728
Orphan claim re-pointed
Claims processor
CLM-419435 → UHC-97068-21 (Jonathan Silva)
Member id
UHC-97068-21
Confidence
1
Method
probabilistic
MBR-004663CLM-419435
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001729
Orphan claim re-pointed
Claims processor
CLM-411499 → UHC-74308-55 (Jack Clark)
Member id
UHC-74308-55
Confidence
0.97
Method
deterministic
MBR-000732CLM-411499
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001730
Orphan claim re-pointed
Claims processor
CLM-416785 → UHC-71651-40 (Vincent Santiago)
Member id
UHC-71651-40
Confidence
0.99
Method
probabilistic
MBR-026351CLM-416785
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001731
Orphan claim re-pointed
Claims processor
CLM-416917 → UHC-34595-03 (Carol Wheeler)
Member id
UHC-34595-03
Confidence
1
Method
probabilistic
MBR-001828CLM-416917
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001732
Orphan claim re-pointed
Claims processor
CLM-400462 → UHC-62709-80 (David Coleman)
Member id
UHC-62709-80
Confidence
1
Method
probabilistic
MBR-018534CLM-400462
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001733
Orphan claim re-pointed
Claims processor
CLM-401089 → UHC-64189-42 (Amy Vargas)
Member id
UHC-64189-42
Confidence
1
Method
probabilistic
MBR-009608CLM-401089
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001734
Orphan claim re-pointed
Claims processor
CLM-428158 → UHC-56916-28 (Logan Larson)
Member id
UHC-56916-28
Confidence
0.97
Method
deterministic
MBR-019372CLM-428158
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001735
Orphan claim re-pointed
Claims processor
CLM-403812 → UHC-53289-31 (Deborah Bishop)
Member id
UHC-53289-31
Confidence
0.85
Method
probabilistic
MBR-022384CLM-403812
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001736
Orphan claim re-pointed
Claims processor
CLM-423017 → UHC-07292-09 (Jen Cooper)
Member id
UHC-07292-09
Confidence
1
Method
probabilistic
MBR-028506CLM-423017
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001737
Orphan claim re-pointed
Claims processor
CLM-412840 → UHC-15044-36 (Ryan Grant)
Member id
UHC-15044-36
Confidence
1
Method
probabilistic
MBR-006882CLM-412840
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001738
Orphan claim re-pointed
Claims processor
CLM-429110 → UHC-44226-46 (Christopher Stevens)
Member id
UHC-44226-46
Confidence
0.97
Method
deterministic
MBR-014505CLM-429110
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001739
Orphan claim re-pointed
Claims processor
CLM-405988 → UHC-80866-65 (Diego Baker)
Member id
UHC-80866-65
Confidence
1
Method
probabilistic
MBR-030953CLM-405988
Executed
resolution_agent
2026-10-19 19:54:39
14,086 rows, page 8 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.