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-005740
Orphan claim re-pointed
Claims processor
CLM-420553 → UHC-90507-70 (Joyce Andrews)
Member id
UHC-90507-70
Confidence
1
Method
probabilistic
MBR-027638CLM-420553
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005741
Orphan claim re-pointed
Claims processor
CLM-420672 → UHC-98691-21 (Mary Weber)
Member id
UHC-98691-21
Confidence
1
Method
probabilistic
MBR-030895CLM-420672
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005742
Orphan claim re-pointed
Claims processor
CLM-410423 → UHC-25604-98 (Ethan Grant)
Member id
UHC-25604-98
Confidence
1
Method
probabilistic
MBR-002277CLM-410423
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005743
Orphan claim re-pointed
Claims processor
CLM-428320 → UHC-05597-29 (Cheryl Reynolds)
Member id
UHC-05597-29
Confidence
0.97
Method
deterministic
MBR-006428CLM-428320
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005744
Orphan claim re-pointed
Claims processor
CLM-406084 → UHC-37995-02 (Santiago Phillips)
Member id
UHC-37995-02
Confidence
1
Method
probabilistic
MBR-031544CLM-406084
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005745
Orphan claim re-pointed
Claims processor
CLM-408480 → UHC-54175-26 (Lauren Green)
Member id
UHC-54175-26
Confidence
0.97
Method
deterministic
MBR-024828CLM-408480
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005746
Orphan claim re-pointed
Claims processor
CLM-419062 → UHC-29299-52 (Samuel Salazar)
Member id
UHC-29299-52
Confidence
1
Method
probabilistic
MBR-008869CLM-419062
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005747
Orphan claim re-pointed
Claims processor
CLM-423076 → UHC-24883-81 (Roger Powell)
Member id
UHC-24883-81
Confidence
0.94
Method
probabilistic
MBR-020831CLM-423076
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005748
Orphan claim re-pointed
Claims processor
CLM-418956 → UHC-96268-40 (Vincent Le)
Member id
UHC-96268-40
Confidence
1
Method
probabilistic
MBR-015298CLM-418956
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005749
Orphan claim re-pointed
Claims processor
CLM-426794 → UHC-72353-72 (George Ford)
Member id
UHC-72353-72
Confidence
1
Method
probabilistic
MBR-029727CLM-426794
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005750
Orphan claim re-pointed
Claims processor
CLM-426555 → UHC-21646-21 (Julie Hughes)
Member id
UHC-21646-21
Confidence
0.97
Method
deterministic
MBR-009165CLM-426555
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005751
Orphan claim re-pointed
Claims processor
CLM-421160 → UHC-58212-49 (Dorothy Riley)
Member id
UHC-58212-49
Confidence
1
Method
probabilistic
MBR-025909CLM-421160
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005752
Orphan claim re-pointed
Claims processor
CLM-401886 → UHC-96771-85 (Brandon Fox)
Member id
UHC-96771-85
Confidence
0.97
Method
deterministic
MBR-013494CLM-401886
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005753
Orphan claim re-pointed
Claims processor
CLM-421818 → UHC-93326-04 (Larry Morales)
Member id
UHC-93326-04
Confidence
1
Method
probabilistic
MBR-036473CLM-421818
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005754
Orphan claim re-pointed
Claims processor
CLM-401139 → UHC-95454-32 (Logan Sims)
Member id
UHC-95454-32
Confidence
1
Method
probabilistic
MBR-004122CLM-401139
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005755
Orphan claim re-pointed
Claims processor
CLM-402351 → UHC-23993-16 (Frances Porter)
Member id
UHC-23993-16
Confidence
0.97
Method
deterministic
MBR-006514CLM-402351
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005756
Orphan claim re-pointed
Claims processor
CLM-426941 → UHC-09489-58 (Catherine Johnson)
Member id
UHC-09489-58
Confidence
1
Method
probabilistic
MBR-002327CLM-426941
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005757
Orphan claim re-pointed
Claims processor
CLM-428685 → UHC-17057-28 (Cynthia Fuller)
Member id
UHC-17057-28
Confidence
1
Method
probabilistic
MBR-016091CLM-428685
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005758
Orphan claim re-pointed
Claims processor
CLM-419333 → UHC-64701-90 (Gregory James)
Member id
UHC-64701-90
Confidence
1
Method
probabilistic
MBR-009446CLM-419333
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005759
Orphan claim re-pointed
Claims processor
CLM-414034 → UHC-39604-78 (Gerald Taylor)
Member id
UHC-39604-78
Confidence
0.97
Method
deterministic
MBR-011218CLM-414034
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005760
Orphan claim re-pointed
Claims processor
CLM-415294 → UHC-12220-96 (Lucia Schmidt)
Member id
UHC-12220-96
Confidence
0.93
Method
probabilistic
MBR-003057CLM-415294
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005761
Orphan claim re-pointed
Claims processor
CLM-417752 → UHC-91470-77 (Heather Pierce)
Member id
UHC-91470-77
Confidence
0.98
Method
probabilistic
MBR-028120CLM-417752
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005762
Orphan claim re-pointed
Claims processor
CLM-402527 → UHC-86194-82 (Joyce Burton)
Member id
UHC-86194-82
Confidence
0.97
Method
deterministic
MBR-039376CLM-402527
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005763
Orphan claim re-pointed
Claims processor
CLM-404247 → UHC-14129-58 (Juhn Sullivan)
Member id
UHC-14129-58
Confidence
0.97
Method
deterministic
MBR-030628CLM-404247
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005764
Orphan claim re-pointed
Claims processor
CLM-428953 → UHC-99604-61 (Susan Richardson)
Member id
UHC-99604-61
Confidence
1
Method
probabilistic
MBR-022626CLM-428953
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005765
Orphan claim re-pointed
Claims processor
CLM-418186 → UHC-96996-81 (Jennifer Powell)
Member id
UHC-96996-81
Confidence
1
Method
probabilistic
MBR-006519CLM-418186
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005766
Orphan claim re-pointed
Claims processor
CLM-402805 → UHC-42263-40 (Bruce Harper)
Member id
UHC-42263-40
Confidence
1
Method
probabilistic
MBR-013124CLM-402805
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005767
Orphan claim re-pointed
Claims processor
CLM-412601 → UHC-10278-83 (Cheryl Crawford)
Member id
UHC-10278-83
Confidence
0.98
Method
probabilistic
MBR-004854CLM-412601
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005768
Orphan claim re-pointed
Claims processor
CLM-407069 → UHC-40503-63 (Nathan Reid)
Member id
UHC-40503-63
Confidence
1
Method
probabilistic
MBR-004729CLM-407069
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005769
Orphan claim re-pointed
Claims processor
CLM-425052 → UHC-92395-20 (Charles Ortiz)
Member id
UHC-92395-20
Confidence
1
Method
probabilistic
MBR-005373CLM-425052
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005770
Orphan claim re-pointed
Claims processor
CLM-401869 → UHC-63167-30 (Nicholas Andrews)
Member id
UHC-63167-30
Confidence
0.97
Method
deterministic
MBR-019326CLM-401869
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005771
Orphan claim re-pointed
Claims processor
CLM-401489 → UHC-17206-25 (Marcus Watson)
Member id
UHC-17206-25
Confidence
0.97
Method
deterministic
MBR-017330CLM-401489
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005772
Orphan claim re-pointed
Claims processor
CLM-408127 → UHC-30664-27 (Ralph Jacobs)
Member id
UHC-30664-27
Confidence
1
Method
probabilistic
MBR-021843CLM-408127
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005773
Orphan claim re-pointed
Claims processor
CLM-408650 → UHC-72503-97 (Jerry Price)
Member id
UHC-72503-97
Confidence
0.97
Method
deterministic
MBR-041940CLM-408650
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005774
Orphan claim re-pointed
Claims processor
CLM-427408 → UHC-46813-22 (Arun Thompson)
Member id
UHC-46813-22
Confidence
0.97
Method
deterministic
MBR-042853CLM-427408
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005775
Orphan claim re-pointed
Claims processor
CLM-424509 → UHC-98583-63 (Bruce Cruz)
Member id
UHC-98583-63
Confidence
0.87
Method
probabilistic
MBR-004239CLM-424509
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005776
Orphan claim re-pointed
Claims processor
CLM-425801 → UHC-51264-75 (Scott Ward)
Member id
UHC-51264-75
Confidence
0.98
Method
probabilistic
MBR-034553CLM-425801
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005777
Orphan claim re-pointed
Claims processor
CLM-407179 → UHC-59277-27 (Kathlean Silva)
Member id
UHC-59277-27
Confidence
0.97
Method
deterministic
MBR-010706CLM-407179
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005778
Orphan claim re-pointed
Claims processor
CLM-418234 → UHC-38273-80 (Eugene Soto)
Member id
UHC-38273-80
Confidence
0.92
Method
probabilistic
MBR-021235CLM-418234
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005779
Orphan claim re-pointed
Claims processor
CLM-409449 → UHC-97966-71 (Bobby Hernandez)
Member id
UHC-97966-71
Confidence
0.97
Method
deterministic
MBR-021805CLM-409449
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005780
Orphan claim re-pointed
Claims processor
CLM-426324 → UHC-99703-83 (Gloria Guzman)
Member id
UHC-99703-83
Confidence
1
Method
probabilistic
MBR-005756CLM-426324
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005781
Orphan claim re-pointed
Claims processor
CLM-422114 → UHC-73625-05 (Gloria Brooks)
Member id
UHC-73625-05
Confidence
0.99
Method
probabilistic
MBR-017971CLM-422114
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005782
Orphan claim re-pointed
Claims processor
CLM-413249 → UHC-39910-13 (Susan Adams)
Member id
UHC-39910-13
Confidence
1
Method
probabilistic
MBR-014755CLM-413249
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005783
Orphan claim re-pointed
Claims processor
CLM-409117 → UHC-16620-48 (Mary Lee)
Member id
UHC-16620-48
Confidence
1
Method
probabilistic
MBR-033457CLM-409117
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005784
Orphan claim re-pointed
Claims processor
CLM-429784 → UHC-40362-42 (Vincent Ward)
Member id
UHC-40362-42
Confidence
1
Method
probabilistic
MBR-020278CLM-429784
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005785
Orphan claim re-pointed
Claims processor
CLM-405440 → UHC-62926-91 (Jesse Hughes)
Member id
UHC-62926-91
Confidence
0.97
Method
deterministic
MBR-004505CLM-405440
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005786
Orphan claim re-pointed
Claims processor
CLM-413031 → UHC-42291-53 (Brittany Lucas)
Member id
UHC-42291-53
Confidence
1
Method
probabilistic
MBR-006797CLM-413031
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005787
Orphan claim re-pointed
Claims processor
CLM-429015 → UHC-46437-60 (Brenda Green)
Member id
UHC-46437-60
Confidence
1
Method
probabilistic
MBR-011069CLM-429015
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005788
Orphan claim re-pointed
Claims processor
CLM-402595 → UHC-52002-05 (Patricia Graham)
Member id
UHC-52002-05
Confidence
0.97
Method
deterministic
MBR-000440CLM-402595
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005789
Orphan claim re-pointed
Claims processor
CLM-427596 → UHC-06931-94 (Joe Chapman)
Member id
UHC-06931-94
Confidence
1
Method
probabilistic
MBR-029165CLM-427596
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 89 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.