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-006090
Orphan claim re-pointed
Claims processor
CLM-416123 → UHC-97348-98 (Carl Schmidt)
Member id
UHC-97348-98
Confidence
1
Method
probabilistic
MBR-024702CLM-416123
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006091
Orphan claim re-pointed
Claims processor
CLM-414765 → UHC-12484-48 (Benjamin Thompson)
Member id
UHC-12484-48
Confidence
1
Method
probabilistic
MBR-012977CLM-414765
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006092
Orphan claim re-pointed
Claims processor
CLM-425608 → UHC-84542-04 (Nicole Evans)
Member id
UHC-84542-04
Confidence
1
Method
probabilistic
MBR-033414CLM-425608
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006093
Orphan claim re-pointed
Claims processor
CLM-419179 → UHC-54196-42 (Gerald Banks)
Member id
UHC-54196-42
Confidence
0.99
Method
probabilistic
MBR-013714CLM-419179
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006094
Orphan claim re-pointed
Claims processor
CLM-421808 → UHC-07105-17 (Tyler Shaw)
Member id
UHC-07105-17
Confidence
1
Method
probabilistic
MBR-029962CLM-421808
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006095
Orphan claim re-pointed
Claims processor
CLM-402492 → UHC-38178-59 (Danielle Bishop)
Member id
UHC-38178-59
Confidence
0.97
Method
deterministic
MBR-009097CLM-402492
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006096
Orphan claim re-pointed
Claims processor
CLM-417899 → UHC-09556-36 (Elizabeth Hanson)
Member id
UHC-09556-36
Confidence
0.93
Method
probabilistic
MBR-018802CLM-417899
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006097
Orphan claim re-pointed
Claims processor
CLM-411521 → UHC-02014-79 (Aigail Franklin)
Member id
UHC-02014-79
Confidence
0.98
Method
probabilistic
MBR-025217CLM-411521
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006098
Orphan claim re-pointed
Claims processor
CLM-413694 → UHC-52339-28 (Jesse Knight)
Member id
UHC-52339-28
Confidence
0.97
Method
deterministic
MBR-024653CLM-413694
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006099
Orphan claim re-pointed
Claims processor
CLM-421402 → UHC-96277-14 (Tyler Hudson)
Member id
UHC-96277-14
Confidence
1
Method
probabilistic
MBR-028544CLM-421402
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006100
Orphan claim re-pointed
Claims processor
CLM-402359 → UHC-74681-79 (Philip Morgan)
Member id
UHC-74681-79
Confidence
1
Method
probabilistic
MBR-001853CLM-402359
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006101
Orphan claim re-pointed
Claims processor
CLM-410835 → UHC-51902-38 (Albert Lucas)
Member id
UHC-51902-38
Confidence
0.99
Method
probabilistic
MBR-015661CLM-410835
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006102
Orphan claim re-pointed
Claims processor
CLM-402886 → UHC-08276-88 (Mark Cole)
Member id
UHC-08276-88
Confidence
0.98
Method
probabilistic
MBR-007195CLM-402886
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006103
Orphan claim re-pointed
Claims processor
CLM-428734 → UHC-44059-63 (Mary Hamilton)
Member id
UHC-44059-63
Confidence
0.94
Method
probabilistic
MBR-006331CLM-428734
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006104
Orphan claim re-pointed
Claims processor
CLM-418505 → UHC-20425-50 (Emma Parker)
Member id
UHC-20425-50
Confidence
0.97
Method
deterministic
MBR-002895CLM-418505
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006105
Orphan claim re-pointed
Claims processor
CLM-423107 → UHC-04176-72 (Raymond Collins)
Member id
UHC-04176-72
Confidence
0.94
Method
probabilistic
MBR-006062CLM-423107
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006106
Orphan claim re-pointed
Claims processor
CLM-408378 → UHC-10242-73 (Ralph Graham)
Member id
UHC-10242-73
Confidence
1
Method
probabilistic
MBR-000817CLM-408378
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006107
Orphan claim re-pointed
Claims processor
CLM-425595 → UHC-29702-93 (Adam Edwards)
Member id
UHC-29702-93
Confidence
0.97
Method
deterministic
MBR-017874CLM-425595
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006108
Orphan claim re-pointed
Claims processor
CLM-411482 → UHC-85426-75 (Madison White)
Member id
UHC-85426-75
Confidence
1
Method
probabilistic
MBR-023737CLM-411482
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006109
Orphan claim re-pointed
Claims processor
CLM-428932 → UHC-89238-83 (Theresa West)
Member id
UHC-89238-83
Confidence
1
Method
probabilistic
MBR-003588CLM-428932
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006110
Orphan claim re-pointed
Claims processor
CLM-406600 → UHC-82645-48 (Douglas Garza)
Member id
UHC-82645-48
Confidence
1
Method
probabilistic
MBR-002425CLM-406600
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006111
Orphan claim re-pointed
Claims processor
CLM-427345 → UHC-40250-67 (Scott Boyd)
Member id
UHC-40250-67
Confidence
1
Method
probabilistic
MBR-009180CLM-427345
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006112
Orphan claim re-pointed
Claims processor
CLM-423682 → UHC-62687-13 (Jerry White)
Member id
UHC-62687-13
Confidence
1
Method
probabilistic
MBR-000884CLM-423682
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006113
Orphan claim re-pointed
Claims processor
CLM-413079 → UHC-94649-01 (Kathryn Moreno)
Member id
UHC-94649-01
Confidence
1
Method
probabilistic
MBR-014624CLM-413079
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006114
Orphan claim re-pointed
Claims processor
CLM-424305 → UHC-81484-49 (Teresa Yang)
Member id
UHC-81484-49
Confidence
1
Method
probabilistic
MBR-013727CLM-424305
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006115
Orphan claim re-pointed
Claims processor
CLM-409667 → UHC-50547-71 (Barb Hansen)
Member id
UHC-50547-71
Confidence
1
Method
probabilistic
MBR-005050CLM-409667
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006116
Orphan claim re-pointed
Claims processor
CLM-424570 → UHC-77317-26 (Eugene Nichols)
Member id
UHC-77317-26
Confidence
1
Method
probabilistic
MBR-002529CLM-424570
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006117
Orphan claim re-pointed
Claims processor
CLM-401252 → UHC-29310-13 (Carlos Scott)
Member id
UHC-29310-13
Confidence
1
Method
probabilistic
MBR-018012CLM-401252
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006118
Orphan claim re-pointed
Claims processor
CLM-416132 → UHC-02598-90 (Michelle Taylor)
Member id
UHC-02598-90
Confidence
1
Method
probabilistic
MBR-004310CLM-416132
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006119
Orphan claim re-pointed
Claims processor
CLM-427595 → UHC-21440-42 (Nathan Wong)
Member id
UHC-21440-42
Confidence
1
Method
probabilistic
MBR-010715CLM-427595
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006120
Orphan claim re-pointed
Claims processor
CLM-432663 → UHC-19912-27 (Emily Stephens)
Member id
UHC-19912-27
Confidence
1
Method
probabilistic
MBR-031110CLM-432663
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006121
Orphan claim re-pointed
Claims processor
CLM-410268 → UHC-53781-65 (Michael Evans)
Member id
UHC-53781-65
Confidence
0.97
Method
deterministic
MBR-031146CLM-410268
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006122
Orphan claim re-pointed
Claims processor
CLM-404711 → UHC-28560-68 (Charles Rice)
Member id
UHC-28560-68
Confidence
1.00
Method
probabilistic
MBR-006164CLM-404711
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006123
Orphan claim re-pointed
Claims processor
CLM-422159 → UHC-65660-37 (Santiago Johnston)
Member id
UHC-65660-37
Confidence
1
Method
probabilistic
MBR-044128CLM-422159
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006124
Orphan claim re-pointed
Claims processor
CLM-412915 → UHC-63686-35 (Robert Bradley)
Member id
UHC-63686-35
Confidence
0.93
Method
probabilistic
MBR-031472CLM-412915
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006125
Orphan claim re-pointed
Claims processor
CLM-421567 → UHC-47477-34 (Julie Singh)
Member id
UHC-47477-34
Confidence
1
Method
probabilistic
MBR-024136CLM-421567
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006126
Orphan claim re-pointed
Claims processor
CLM-411887 → UHC-85455-92 (Pamela Lucas)
Member id
UHC-85455-92
Confidence
1
Method
probabilistic
MBR-022043CLM-411887
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006127
Orphan claim re-pointed
Claims processor
CLM-413803 → UHC-39549-73 (Henry Johnson)
Member id
UHC-39549-73
Confidence
0.99
Method
probabilistic
MBR-006125CLM-413803
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006128
Orphan claim re-pointed
Claims processor
CLM-428750 → UHC-81652-63 (Danielle Chen)
Member id
UHC-81652-63
Confidence
1
Method
probabilistic
MBR-006694CLM-428750
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006129
Orphan claim re-pointed
Claims processor
CLM-406795 → UHC-90670-68 (Gloria Estrada)
Member id
UHC-90670-68
Confidence
1
Method
probabilistic
MBR-009488CLM-406795
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006130
Orphan claim re-pointed
Claims processor
CLM-402411 → UHC-12831-60 (Debra Romero)
Member id
UHC-12831-60
Confidence
1
Method
probabilistic
MBR-003446CLM-402411
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006131
Orphan claim re-pointed
Claims processor
CLM-421988 → UHC-13352-81 (Janice Riley)
Member id
UHC-13352-81
Confidence
0.94
Method
probabilistic
MBR-032507CLM-421988
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006132
Orphan claim re-pointed
Claims processor
CLM-419671 → UHC-07485-72 (William Singh)
Member id
UHC-07485-72
Confidence
1
Method
probabilistic
MBR-003479CLM-419671
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006133
Orphan claim re-pointed
Claims processor
CLM-424702 → UHC-58169-52 (Diane Morales)
Member id
UHC-58169-52
Confidence
1
Method
probabilistic
MBR-029306CLM-424702
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006134
Orphan claim re-pointed
Claims processor
CLM-411958 → UHC-63413-52 (Abigail Taylor)
Member id
UHC-63413-52
Confidence
1
Method
probabilistic
MBR-016037CLM-411958
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006135
Orphan claim re-pointed
Claims processor
CLM-431968 → UHC-46657-20 (Randy Foster)
Member id
UHC-46657-20
Confidence
1
Method
probabilistic
MBR-019956CLM-431968
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006136
Orphan claim re-pointed
Claims processor
CLM-403806 → UHC-24980-13 (Austin Mendoza)
Member id
UHC-24980-13
Confidence
0.97
Method
deterministic
MBR-019580CLM-403806
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006137
Orphan claim re-pointed
Claims processor
CLM-404322 → UHC-01641-97 (John Hayes)
Member id
UHC-01641-97
Confidence
0.97
Method
probabilistic
MBR-027981CLM-404322
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006138
Orphan claim re-pointed
Claims processor
CLM-403159 → UHC-48058-63 (Diana Reid)
Member id
UHC-48058-63
Confidence
1
Method
probabilistic
MBR-000111CLM-403159
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006139
Orphan claim re-pointed
Claims processor
CLM-408419 → UHC-61312-95 (Zachary Weber)
Member id
UHC-61312-95
Confidence
1
Method
probabilistic
MBR-017850CLM-408419
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 96 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.