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-001740
Orphan claim re-pointed
Claims processor
CLM-430660 → UHC-26690-16 (Judith Schultz)
Member id
UHC-26690-16
Confidence
1
Method
probabilistic
MBR-012876CLM-430660
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001741
Orphan claim re-pointed
Claims processor
CLM-408005 → UHC-99324-88 (Amy Franklin)
Member id
UHC-99324-88
Confidence
0.97
Method
deterministic
MBR-001824CLM-408005
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001742
Orphan claim re-pointed
Claims processor
CLM-402499 → UHC-34796-81 (Brandon Jenkins)
Member id
UHC-34796-81
Confidence
1
Method
probabilistic
MBR-016913CLM-402499
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001743
Orphan claim re-pointed
Claims processor
CLM-409918 → UHC-51890-28 (Gerald Collins)
Member id
UHC-51890-28
Confidence
0.99
Method
probabilistic
MBR-002610CLM-409918
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001744
Orphan claim re-pointed
Claims processor
CLM-406018 → UHC-73426-48 (Kayla Bell)
Member id
UHC-73426-48
Confidence
1
Method
probabilistic
MBR-001435CLM-406018
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001745
Orphan claim re-pointed
Claims processor
CLM-404641 → UHC-56584-90 (Debra Marquez)
Member id
UHC-56584-90
Confidence
1
Method
probabilistic
MBR-001331CLM-404641
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001746
Orphan claim re-pointed
Claims processor
CLM-407283 → UHC-97077-15 (Dylan Rojas)
Member id
UHC-97077-15
Confidence
1
Method
probabilistic
MBR-007714CLM-407283
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001747
Orphan claim re-pointed
Claims processor
CLM-404729 → UHC-29195-03 (Jesse Hernandez)
Member id
UHC-29195-03
Confidence
1
Method
probabilistic
MBR-017638CLM-404729
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001748
Orphan claim re-pointed
Claims processor
CLM-415392 → UHC-75813-69 (Mariana Valdez)
Member id
UHC-75813-69
Confidence
0.99
Method
probabilistic
MBR-009951CLM-415392
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001749
Orphan claim re-pointed
Claims processor
CLM-429098 → UHC-37730-93 (Emily Ramirez)
Member id
UHC-37730-93
Confidence
1
Method
probabilistic
MBR-005932CLM-429098
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001750
Orphan claim re-pointed
Claims processor
CLM-410897 → UHC-14493-37 (Cheryl Kennedy)
Member id
UHC-14493-37
Confidence
1
Method
probabilistic
MBR-022620CLM-410897
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001751
Orphan claim re-pointed
Claims processor
CLM-413707 → UHC-47164-26 (Santiago Moore)
Member id
UHC-47164-26
Confidence
0.98
Method
probabilistic
MBR-007220CLM-413707
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001752
Orphan claim re-pointed
Claims processor
CLM-427249 → UHC-02784-11 (Joshua Rose)
Member id
UHC-02784-11
Confidence
1
Method
probabilistic
MBR-007811CLM-427249
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001753
Orphan claim re-pointed
Claims processor
CLM-412951 → UHC-61964-52 (Jennifer Watson)
Member id
UHC-61964-52
Confidence
0.99
Method
probabilistic
MBR-010890CLM-412951
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001754
Orphan claim re-pointed
Claims processor
CLM-404600 → UHC-47652-65 (Deborah Vazquez)
Member id
UHC-47652-65
Confidence
0.94
Method
probabilistic
MBR-013385CLM-404600
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001755
Orphan claim re-pointed
Claims processor
CLM-401639 → UHC-90696-28 (Charles Marquez)
Member id
UHC-90696-28
Confidence
1
Method
probabilistic
MBR-028422CLM-401639
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001756
Orphan claim re-pointed
Claims processor
CLM-418267 → UHC-79734-63 (Lucia Jensen)
Member id
UHC-79734-63
Confidence
1
Method
probabilistic
MBR-006172CLM-418267
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001757
Orphan claim re-pointed
Claims processor
CLM-430201 → UHC-22797-90 (Philip Olson)
Member id
UHC-22797-90
Confidence
1
Method
probabilistic
MBR-019656CLM-430201
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001758
Orphan claim re-pointed
Claims processor
CLM-424354 → UHC-11129-89 (Henry Ruiz)
Member id
UHC-11129-89
Confidence
0.97
Method
deterministic
MBR-013955CLM-424354
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001759
Orphan claim re-pointed
Claims processor
CLM-415467 → UHC-89857-59 (Zachary Munoz)
Member id
UHC-89857-59
Confidence
1
Method
probabilistic
MBR-025804CLM-415467
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001760
Orphan claim re-pointed
Claims processor
CLM-430365 → UHC-56559-86 (Andrea Ortiz)
Member id
UHC-56559-86
Confidence
1
Method
probabilistic
MBR-023759CLM-430365
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001761
Orphan claim re-pointed
Claims processor
CLM-411702 → UHC-00977-64 (Wei Robinson)
Member id
UHC-00977-64
Confidence
1
Method
probabilistic
MBR-008409CLM-411702
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001762
Orphan claim re-pointed
Claims processor
CLM-428926 → UHC-86763-22 (Kimberly Bell)
Member id
UHC-86763-22
Confidence
1
Method
probabilistic
MBR-018763CLM-428926
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001763
Orphan claim re-pointed
Claims processor
CLM-420852 → UHC-17253-37 (Jean Espinoza)
Member id
UHC-17253-37
Confidence
1
Method
probabilistic
MBR-018268CLM-420852
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001764
Orphan claim re-pointed
Claims processor
CLM-431108 → UHC-59244-39 (Jean McCoy)
Member id
UHC-59244-39
Confidence
0.90
Method
probabilistic
MBR-021128CLM-431108
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001765
Orphan claim re-pointed
Claims processor
CLM-400634 → UHC-86309-43 (Brian Cole)
Member id
UHC-86309-43
Confidence
1
Method
probabilistic
MBR-027696CLM-400634
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001766
Orphan claim re-pointed
Claims processor
CLM-420559 → UHC-02890-41 (Nancy Ferguson)
Member id
UHC-02890-41
Confidence
1
Method
probabilistic
MBR-015987CLM-420559
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001767
Orphan claim re-pointed
Claims processor
CLM-432307 → UHC-41143-37 (Kayla Valdez)
Member id
UHC-41143-37
Confidence
1
Method
probabilistic
MBR-004577CLM-432307
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001768
Orphan claim re-pointed
Claims processor
CLM-405655 → UHC-19050-62 (Victoria Evans)
Member id
UHC-19050-62
Confidence
1
Method
probabilistic
MBR-024954CLM-405655
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001769
Orphan claim re-pointed
Claims processor
CLM-430432 → UHC-51846-88 (Joan Medina)
Member id
UHC-51846-88
Confidence
0.97
Method
deterministic
MBR-026812CLM-430432
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001770
Orphan claim re-pointed
Claims processor
CLM-416065 → UHC-48858-85 (Ralph Myers)
Member id
UHC-48858-85
Confidence
0.94
Method
probabilistic
MBR-002827CLM-416065
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001771
Orphan claim re-pointed
Claims processor
CLM-407520 → UHC-06605-29 (Patricia Grant)
Member id
UHC-06605-29
Confidence
1
Method
probabilistic
MBR-034054CLM-407520
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001772
Orphan claim re-pointed
Claims processor
CLM-403435 → UHC-56279-29 (Ryan Patel)
Member id
UHC-56279-29
Confidence
1
Method
probabilistic
MBR-027097CLM-403435
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001773
Orphan claim re-pointed
Claims processor
CLM-425915 → UHC-60558-56 (Ruth Ross)
Member id
UHC-60558-56
Confidence
1
Method
probabilistic
MBR-001545CLM-425915
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001774
Orphan claim re-pointed
Claims processor
CLM-407151 → UHC-38319-19 (Hannah Rose)
Member id
UHC-38319-19
Confidence
1
Method
probabilistic
MBR-006459CLM-407151
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001775
Orphan claim re-pointed
Claims processor
CLM-416509 → UHC-83152-41 (Roy Watson)
Member id
UHC-83152-41
Confidence
1
Method
probabilistic
MBR-013024CLM-416509
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001776
Orphan claim re-pointed
Claims processor
CLM-425315 → UHC-76683-43 (Ralph Henderson)
Member id
UHC-76683-43
Confidence
1
Method
probabilistic
MBR-038548CLM-425315
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001777
Orphan claim re-pointed
Claims processor
CLM-401865 → UHC-30122-51 (Gary Walker)
Member id
UHC-30122-51
Confidence
1
Method
probabilistic
MBR-008924CLM-401865
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001778
Orphan claim re-pointed
Claims processor
CLM-419111 → UHC-14047-09 (Jackie Nelson)
Member id
UHC-14047-09
Confidence
1
Method
probabilistic
MBR-008961CLM-419111
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001779
Orphan claim re-pointed
Claims processor
CLM-423073 → UHC-62601-51 (Shirley Obrien)
Member id
UHC-62601-51
Confidence
1
Method
probabilistic
MBR-003413CLM-423073
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001780
Orphan claim re-pointed
Claims processor
CLM-419398 → UHC-98369-55 (Doris Fernandez)
Member id
UHC-98369-55
Confidence
1
Method
probabilistic
MBR-011047CLM-419398
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001781
Orphan claim re-pointed
Claims processor
CLM-410142 → UHC-63728-04 (William Contreras)
Member id
UHC-63728-04
Confidence
1
Method
probabilistic
MBR-012337CLM-410142
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001782
Orphan claim re-pointed
Claims processor
CLM-416034 → UHC-76735-60 (Mateo Chen)
Member id
UHC-76735-60
Confidence
0.97
Method
deterministic
MBR-006431CLM-416034
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001783
Orphan claim re-pointed
Claims processor
CLM-425345 → UHC-20067-85 (Lawrence Gutierrez)
Member id
UHC-20067-85
Confidence
0.97
Method
deterministic
MBR-017425CLM-425345
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001784
Orphan claim re-pointed
Claims processor
CLM-409016 → UHC-59953-53 (Michelle Kennedy)
Member id
UHC-59953-53
Confidence
0.97
Method
deterministic
MBR-014323CLM-409016
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001785
Orphan claim re-pointed
Claims processor
CLM-417137 → UHC-61321-56 (Christine Davis)
Member id
UHC-61321-56
Confidence
1
Method
probabilistic
MBR-008504CLM-417137
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001786
Orphan claim re-pointed
Claims processor
CLM-400555 → UHC-38544-97 (Frances Wilson)
Member id
UHC-38544-97
Confidence
1
Method
probabilistic
MBR-035057CLM-400555
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001787
Orphan claim re-pointed
Claims processor
CLM-404850 → UHC-74882-51 (Heather McDonald)
Member id
UHC-74882-51
Confidence
0.97
Method
deterministic
MBR-013495CLM-404850
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001788
Orphan claim re-pointed
Claims processor
CLM-400680 → UHC-06356-88 (Evelyn Brooks)
Member id
UHC-06356-88
Confidence
1
Method
probabilistic
MBR-022201CLM-400680
Executed
resolution_agent
2026-10-19 19:54:39
ACT-001789
Orphan claim re-pointed
Claims processor
CLM-431545 → UHC-60838-89 (Christian Henry)
Member id
UHC-60838-89
Confidence
0.99
Method
probabilistic
MBR-008611CLM-431545
Executed
resolution_agent
2026-10-19 19:54:39
14,086 rows, page 9 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.