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-005840
Orphan claim re-pointed
Claims processor
CLM-400281 → UHC-00473-04 (Madison Harris)
Member id
UHC-00473-04
Confidence
1
Method
probabilistic
MBR-021140CLM-400281
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005841
Orphan claim re-pointed
Claims processor
CLM-413279 → UHC-14067-97 (Abigail Dunn)
Member id
UHC-14067-97
Confidence
0.97
Method
deterministic
MBR-028468CLM-413279
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005842
Orphan claim re-pointed
Claims processor
CLM-421380 → UHC-64036-10 (Alexis Hill)
Member id
UHC-64036-10
Confidence
0.99
Method
probabilistic
MBR-005140CLM-421380
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005843
Orphan claim re-pointed
Claims processor
CLM-429869 → UHC-72120-49 (Austin Contreras)
Member id
UHC-72120-49
Confidence
1
Method
probabilistic
MBR-017712CLM-429869
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005844
Orphan claim re-pointed
Claims processor
CLM-424128 → UHC-90970-56 (Justni Boyd)
Member id
UHC-90970-56
Confidence
0.97
Method
deterministic
MBR-016292CLM-424128
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005845
Orphan claim re-pointed
Claims processor
CLM-428937 → UHC-54715-07 (Camila Walker)
Member id
UHC-54715-07
Confidence
0.97
Method
deterministic
MBR-023018CLM-428937
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005846
Orphan claim re-pointed
Claims processor
CLM-414082 → UHC-96632-86 (James Price)
Member id
UHC-96632-86
Confidence
1
Method
probabilistic
MBR-003090CLM-414082
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005847
Orphan claim re-pointed
Claims processor
CLM-428036 → UHC-47330-63 (Doris Rogers)
Member id
UHC-47330-63
Confidence
1
Method
probabilistic
MBR-027057CLM-428036
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005848
Orphan claim re-pointed
Claims processor
CLM-423719 → UHC-82582-51 (Diane Schultz)
Member id
UHC-82582-51
Confidence
1
Method
probabilistic
MBR-022729CLM-423719
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005849
Orphan claim re-pointed
Claims processor
CLM-415802 → UHC-77710-35 (Brian Daniels)
Member id
UHC-77710-35
Confidence
1
Method
probabilistic
MBR-038827CLM-415802
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005850
Orphan claim re-pointed
Claims processor
CLM-412509 → UHC-84016-21 (Carlos Guerrero)
Member id
UHC-84016-21
Confidence
0.99
Method
probabilistic
MBR-004234CLM-412509
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005851
Orphan claim re-pointed
Claims processor
CLM-412312 → UHC-90814-20 (Barbara Schultz)
Member id
UHC-90814-20
Confidence
1
Method
probabilistic
MBR-030313CLM-412312
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005852
Orphan claim re-pointed
Claims processor
CLM-415932 → UHC-24604-43 (Tony Berry)
Member id
UHC-24604-43
Confidence
1
Method
probabilistic
MBR-043160CLM-415932
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005853
Orphan claim re-pointed
Claims processor
CLM-409285 → UHC-53823-26 (Sandra Fox)
Member id
UHC-53823-26
Confidence
1
Method
probabilistic
MBR-033363CLM-409285
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005854
Orphan claim re-pointed
Claims processor
CLM-428811 → UHC-13247-56 (Dylan Lynch)
Member id
UHC-13247-56
Confidence
1
Method
probabilistic
MBR-019643CLM-428811
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005855
Orphan claim re-pointed
Claims processor
CLM-403045 → UHC-44063-25 (Brittany Kim)
Member id
UHC-44063-25
Confidence
1
Method
probabilistic
MBR-023566CLM-403045
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005856
Orphan claim re-pointed
Claims processor
CLM-412847 → UHC-98312-99 (Jerry Romero)
Member id
UHC-98312-99
Confidence
0.97
Method
deterministic
MBR-023099CLM-412847
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005857
Orphan claim re-pointed
Claims processor
CLM-427466 → UHC-46144-67 (Bryan Alvarez)
Member id
UHC-46144-67
Confidence
0.97
Method
deterministic
MBR-013254CLM-427466
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005858
Orphan claim re-pointed
Claims processor
CLM-430975 → UHC-90564-84 (Diane Olson)
Member id
UHC-90564-84
Confidence
1
Method
probabilistic
MBR-005647CLM-430975
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005859
Orphan claim re-pointed
Claims processor
CLM-430274 → UHC-12731-65 (Sofia McCoy)
Member id
UHC-12731-65
Confidence
1
Method
probabilistic
MBR-012905CLM-430274
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005860
Orphan claim re-pointed
Claims processor
CLM-431609 → UHC-75026-55 (Carolyn Flores)
Member id
UHC-75026-55
Confidence
1
Method
probabilistic
MBR-000658CLM-431609
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005861
Orphan claim re-pointed
Claims processor
CLM-429269 → UHC-12979-32 (Amanda Day)
Member id
UHC-12979-32
Confidence
0.97
Method
deterministic
MBR-000047CLM-429269
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005862
Orphan claim re-pointed
Claims processor
CLM-403565 → UHC-64123-35 (Martha Turner)
Member id
UHC-64123-35
Confidence
0.97
Method
deterministic
MBR-034783CLM-403565
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005863
Orphan claim re-pointed
Claims processor
CLM-417300 → UHC-34728-46 (Diego Hunt)
Member id
UHC-34728-46
Confidence
1
Method
probabilistic
MBR-006371CLM-417300
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005864
Orphan claim re-pointed
Claims processor
CLM-409140 → UHC-27852-28 (Kelly Ferguson)
Member id
UHC-27852-28
Confidence
1
Method
probabilistic
MBR-023337CLM-409140
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005865
Orphan claim re-pointed
Claims processor
CLM-410735 → UHC-21146-73 (Christian Gutierrez)
Member id
UHC-21146-73
Confidence
0.97
Method
deterministic
MBR-032257CLM-410735
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005866
Orphan claim re-pointed
Claims processor
CLM-427913 → UHC-01972-71 (Denise Little)
Member id
UHC-01972-71
Confidence
1
Method
probabilistic
MBR-020264CLM-427913
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005867
Orphan claim re-pointed
Claims processor
CLM-426433 → UHC-60488-61 (Jennfier Carroll)
Member id
UHC-60488-61
Confidence
1.00
Method
probabilistic
MBR-025352CLM-426433
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005868
Orphan claim re-pointed
Claims processor
CLM-413858 → UHC-35192-79 (Justin Montgomery)
Member id
UHC-35192-79
Confidence
1
Method
probabilistic
MBR-011199CLM-413858
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005869
Orphan claim re-pointed
Claims processor
CLM-415347 → UHC-43459-75 (Margaret Obrien)
Member id
UHC-43459-75
Confidence
0.97
Method
deterministic
MBR-027484CLM-415347
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005870
Orphan claim re-pointed
Claims processor
CLM-430780 → UHC-14819-53 (Rebecca Jacobs)
Member id
UHC-14819-53
Confidence
0.99
Method
probabilistic
MBR-021607CLM-430780
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005871
Orphan claim re-pointed
Claims processor
CLM-400254 → UHC-21741-37 (Henry Brown)
Member id
UHC-21741-37
Confidence
1
Method
probabilistic
MBR-010847CLM-400254
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005872
Orphan claim re-pointed
Claims processor
CLM-420238 → UHC-80935-14 (Katherine Patel)
Member id
UHC-80935-14
Confidence
1
Method
probabilistic
MBR-007014CLM-420238
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005873
Orphan claim re-pointed
Claims processor
CLM-401835 → UHC-69471-08 (Cynthia Ray)
Member id
UHC-69471-08
Confidence
1.00
Method
probabilistic
MBR-016886CLM-401835
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005874
Orphan claim re-pointed
Claims processor
CLM-405670 → UHC-82913-21 (Diego Johnston)
Member id
UHC-82913-21
Confidence
1
Method
probabilistic
MBR-019899CLM-405670
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005875
Orphan claim re-pointed
Claims processor
CLM-426425 → UHC-56145-05 (Amandda Webre)
Member id
UHC-56145-05
Confidence
0.99
Method
probabilistic
MBR-014042CLM-426425
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005876
Orphan claim re-pointed
Claims processor
CLM-412747 → UHC-33244-23 (Nicole Weber)
Member id
UHC-33244-23
Confidence
1
Method
probabilistic
MBR-010566CLM-412747
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005877
Orphan claim re-pointed
Claims processor
CLM-413848 → UHC-30106-17 (Evelyn Coleman)
Member id
UHC-30106-17
Confidence
1
Method
probabilistic
MBR-002558CLM-413848
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005878
Orphan claim re-pointed
Claims processor
CLM-430832 → UHC-52083-96 (Jesse Kim)
Member id
UHC-52083-96
Confidence
1
Method
probabilistic
MBR-004548CLM-430832
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005879
Orphan claim re-pointed
Claims processor
CLM-414243 → UHC-15395-10 (Jessica Morgan)
Member id
UHC-15395-10
Confidence
1
Method
probabilistic
MBR-015613CLM-414243
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005880
Orphan claim re-pointed
Claims processor
CLM-420119 → UHC-51797-42 (Steven Rios)
Member id
UHC-51797-42
Confidence
1
Method
probabilistic
MBR-021387CLM-420119
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005881
Orphan claim re-pointed
Claims processor
CLM-405603 → UHC-31863-51 (Raymond Gardner)
Member id
UHC-31863-51
Confidence
1
Method
probabilistic
MBR-005342CLM-405603
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005882
Orphan claim re-pointed
Claims processor
CLM-429265 → UHC-49834-84 (Terry Russell)
Member id
UHC-49834-84
Confidence
1
Method
probabilistic
MBR-017538CLM-429265
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005883
Orphan claim re-pointed
Claims processor
CLM-427763 → UHC-67198-90 (David Coleman)
Member id
UHC-67198-90
Confidence
0.93
Method
probabilistic
MBR-026213CLM-427763
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005884
Orphan claim re-pointed
Claims processor
CLM-422301 → UHC-28465-51 (Kimberly Armstrong)
Member id
UHC-28465-51
Confidence
1
Method
probabilistic
MBR-026801CLM-422301
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005885
Orphan claim re-pointed
Claims processor
CLM-418483 → UHC-78489-07 (Yuki Salazar)
Member id
UHC-78489-07
Confidence
0.93
Method
probabilistic
MBR-008998CLM-418483
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005886
Orphan claim re-pointed
Claims processor
CLM-410627 → UHC-86329-70 (Cynthia Ryan)
Member id
UHC-86329-70
Confidence
1
Method
probabilistic
MBR-017658CLM-410627
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005887
Orphan claim re-pointed
Claims processor
CLM-419081 → UHC-49124-60 (Margaret Parker)
Member id
UHC-49124-60
Confidence
0.97
Method
deterministic
MBR-028860CLM-419081
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005888
Orphan claim re-pointed
Claims processor
CLM-402270 → UHC-83618-98 (Camila Martinez)
Member id
UHC-83618-98
Confidence
1
Method
probabilistic
MBR-032157CLM-402270
Executed
resolution_agent
2026-10-22 12:47:23
ACT-005889
Orphan claim re-pointed
Claims processor
CLM-413247 → UHC-30977-89 (Kimberly Lawson)
Member id
UHC-30977-89
Confidence
0.97
Method
deterministic
MBR-016957CLM-413247
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 91 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.