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-006140
Orphan claim re-pointed
Claims processor
CLM-408791 → UHC-43424-68 (Susan Torres)
Member id
UHC-43424-68
Confidence
1
Method
probabilistic
MBR-014330CLM-408791
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006141
Orphan claim re-pointed
Claims processor
CLM-426930 → UHC-66065-50 (Sean Howell)
Member id
UHC-66065-50
Confidence
0.99
Method
probabilistic
MBR-029859CLM-426930
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006142
Orphan claim re-pointed
Claims processor
CLM-413505 → UHC-44097-04 (Julie Parker)
Member id
UHC-44097-04
Confidence
1
Method
probabilistic
MBR-003884CLM-413505
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006143
Orphan claim re-pointed
Claims processor
CLM-429940 → UHC-39409-51 (Lauren Johnson)
Member id
UHC-39409-51
Confidence
1
Method
probabilistic
MBR-001513CLM-429940
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006144
Orphan claim re-pointed
Claims processor
CLM-400514 → UHC-27977-55 (Kimberly Henry)
Member id
UHC-27977-55
Confidence
0.97
Method
deterministic
MBR-030115CLM-400514
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006145
Orphan claim re-pointed
Claims processor
CLM-432097 → UHC-31595-46 (Terry Spencer)
Member id
UHC-31595-46
Confidence
1
Method
probabilistic
MBR-036863CLM-432097
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006146
Orphan claim re-pointed
Claims processor
CLM-429871 → UHC-84706-98 (Ronald Mejia)
Member id
UHC-84706-98
Confidence
0.93
Method
probabilistic
MBR-028780CLM-429871
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006147
Orphan claim re-pointed
Claims processor
CLM-428479 → UHC-33993-62 (Linda Boyd)
Member id
UHC-33993-62
Confidence
1
Method
probabilistic
MBR-019634CLM-428479
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006148
Orphan claim re-pointed
Claims processor
CLM-423246 → UHC-54923-39 (Sophia Lawrence)
Member id
UHC-54923-39
Confidence
0.99
Method
probabilistic
MBR-000360CLM-423246
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006149
Orphan claim re-pointed
Claims processor
CLM-402117 → UHC-66088-38 (Mary Pena)
Member id
UHC-66088-38
Confidence
1
Method
probabilistic
MBR-040157CLM-402117
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006150
Orphan claim re-pointed
Claims processor
CLM-421652 → UHC-53180-18 (Mark Washington)
Member id
UHC-53180-18
Confidence
0.97
Method
deterministic
MBR-004115CLM-421652
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006151
Orphan claim re-pointed
Claims processor
CLM-410518 → UHC-39798-52 (Diego Martin)
Member id
UHC-39798-52
Confidence
0.89
Method
probabilistic
MBR-017702CLM-410518
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006152
Orphan claim re-pointed
Claims processor
CLM-414612 → UHC-67775-91 (Mark Johnston)
Member id
UHC-67775-91
Confidence
1
Method
probabilistic
MBR-009605CLM-414612
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006153
Orphan claim re-pointed
Claims processor
CLM-431206 → UHC-72195-70 (Gary Montgomery)
Member id
UHC-72195-70
Confidence
1
Method
probabilistic
MBR-012556CLM-431206
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006154
Orphan claim re-pointed
Claims processor
CLM-413695 → UHC-43246-74 (David Luna)
Member id
UHC-43246-74
Confidence
1
Method
probabilistic
MBR-001464CLM-413695
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006155
Orphan claim re-pointed
Claims processor
CLM-422116 → UHC-87446-72 (Samantha Kelly)
Member id
UHC-87446-72
Confidence
1
Method
probabilistic
MBR-009615CLM-422116
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006156
Orphan claim re-pointed
Claims processor
CLM-422775 → UHC-69449-60 (Brenda Simmons)
Member id
UHC-69449-60
Confidence
1
Method
probabilistic
MBR-018119CLM-422775
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006157
Orphan claim re-pointed
Claims processor
CLM-431439 → UHC-86939-73 (Ann Hoffman)
Member id
UHC-86939-73
Confidence
1
Method
probabilistic
MBR-005771CLM-431439
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006158
Orphan claim re-pointed
Claims processor
CLM-419938 → UHC-92907-25 (Mateo Diaz)
Member id
UHC-92907-25
Confidence
1
Method
probabilistic
MBR-007680CLM-419938
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006159
Orphan claim re-pointed
Claims processor
CLM-424757 → UHC-54543-72 (Thomas Matthews)
Member id
UHC-54543-72
Confidence
0.99
Method
probabilistic
MBR-019511CLM-424757
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006160
Orphan claim re-pointed
Claims processor
CLM-417404 → UHC-42860-23 (Jeremy Palmer)
Member id
UHC-42860-23
Confidence
1
Method
probabilistic
MBR-024543CLM-417404
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006161
Orphan claim re-pointed
Claims processor
CLM-424270 → UHC-58851-08 (Jack Barnes)
Member id
UHC-58851-08
Confidence
1
Method
probabilistic
MBR-005830CLM-424270
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006162
Orphan claim re-pointed
Claims processor
CLM-425569 → UHC-72694-61 (Peter Cunningham)
Member id
UHC-72694-61
Confidence
1
Method
probabilistic
MBR-023260CLM-425569
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006163
Orphan claim re-pointed
Claims processor
CLM-403040 → UHC-14388-64 (Amber Woods)
Member id
UHC-14388-64
Confidence
1
Method
probabilistic
MBR-030450CLM-403040
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006164
Orphan claim re-pointed
Claims processor
CLM-409870 → UHC-03136-08 (Adam Owens)
Member id
UHC-03136-08
Confidence
0.99
Method
probabilistic
MBR-001781CLM-409870
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006165
Orphan claim re-pointed
Claims processor
CLM-410366 → UHC-42460-12 (Edward Peterson)
Member id
UHC-42460-12
Confidence
1
Method
probabilistic
MBR-004725CLM-410366
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006166
Orphan claim re-pointed
Claims processor
CLM-410011 → UHC-50913-71 (Cynthia Contreras)
Member id
UHC-50913-71
Confidence
1
Method
probabilistic
MBR-030178CLM-410011
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006167
Orphan claim re-pointed
Claims processor
CLM-418046 → UHC-70128-75 (Joseph Hunt)
Member id
UHC-70128-75
Confidence
1
Method
probabilistic
MBR-014552CLM-418046
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006168
Orphan claim re-pointed
Claims processor
CLM-426746 → UHC-40588-93 (Brenda Butler)
Member id
UHC-40588-93
Confidence
1
Method
probabilistic
MBR-007584CLM-426746
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006169
Orphan claim re-pointed
Claims processor
CLM-407188 → UHC-52970-96 (Linda Obrien)
Member id
UHC-52970-96
Confidence
1
Method
probabilistic
MBR-033382CLM-407188
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006170
Orphan claim re-pointed
Claims processor
CLM-427864 → UHC-68305-08 (Jacqueline Young)
Member id
UHC-68305-08
Confidence
1
Method
probabilistic
MBR-020888CLM-427864
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006171
Orphan claim re-pointed
Claims processor
CLM-424801 → UHC-28305-27 (Dennis Rivera)
Member id
UHC-28305-27
Confidence
0.97
Method
deterministic
MBR-026782CLM-424801
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006172
Orphan claim re-pointed
Claims processor
CLM-428430 → UHC-21433-81 (John Lewis)
Member id
UHC-21433-81
Confidence
0.93
Method
probabilistic
MBR-028824CLM-428430
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006173
Orphan claim re-pointed
Claims processor
CLM-422563 → UHC-30535-48 (Dylan Reid)
Member id
UHC-30535-48
Confidence
1
Method
probabilistic
MBR-017677CLM-422563
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006174
Orphan claim re-pointed
Claims processor
CLM-409281 → UHC-94005-32 (Rachel Elliott)
Member id
UHC-94005-32
Confidence
0.97
Method
deterministic
MBR-016902CLM-409281
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006175
Orphan claim re-pointed
Claims processor
CLM-400550 → UHC-19081-16 (Amy Wong)
Member id
UHC-19081-16
Confidence
1
Method
probabilistic
MBR-001523CLM-400550
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006176
Orphan claim re-pointed
Claims processor
CLM-412189 → UHC-94061-26 (Mary Ellis)
Member id
UHC-94061-26
Confidence
1
Method
probabilistic
MBR-032131CLM-412189
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006177
Orphan claim re-pointed
Claims processor
CLM-430366 → UHC-56559-86 (Andrea Ortiz)
Member id
UHC-56559-86
Confidence
1
Method
probabilistic
MBR-023759CLM-430366
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006178
Orphan claim re-pointed
Claims processor
CLM-411395 → UHC-64102-34 (Jacob Kelly)
Member id
UHC-64102-34
Confidence
0.93
Method
probabilistic
MBR-000232CLM-411395
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006179
Orphan claim re-pointed
Claims processor
CLM-405360 → UHC-12406-55 (Betty Warren)
Member id
UHC-12406-55
Confidence
1
Method
probabilistic
MBR-004104CLM-405360
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006180
Orphan claim re-pointed
Claims processor
CLM-405074 → UHC-63822-79 (Madison Hawkins)
Member id
UHC-63822-79
Confidence
1.00
Method
probabilistic
MBR-034154CLM-405074
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006181
Orphan claim re-pointed
Claims processor
CLM-416500 → UHC-43078-98 (Gary Vazquez)
Member id
UHC-43078-98
Confidence
0.97
Method
deterministic
MBR-005247CLM-416500
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006182
Orphan claim re-pointed
Claims processor
CLM-409402 → UHC-69356-13 (Arjun Sullivan)
Member id
UHC-69356-13
Confidence
1
Method
probabilistic
MBR-005474CLM-409402
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006183
Orphan claim re-pointed
Claims processor
CLM-431957 → UHC-42973-31 (Danielle Cruz)
Member id
UHC-42973-31
Confidence
1
Method
probabilistic
MBR-013819CLM-431957
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006184
Orphan claim re-pointed
Claims processor
CLM-412433 → UHC-71248-55 (Alice Henry)
Member id
UHC-71248-55
Confidence
0.94
Method
probabilistic
MBR-030383CLM-412433
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006185
Orphan claim re-pointed
Claims processor
CLM-411966 → UHC-91109-19 (Megan Herrera)
Member id
UHC-91109-19
Confidence
0.93
Method
probabilistic
MBR-002660CLM-411966
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006186
Orphan claim re-pointed
Claims processor
CLM-425935 → UHC-64578-92 (Brenda Robinson)
Member id
UHC-64578-92
Confidence
0.97
Method
deterministic
MBR-040731CLM-425935
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006187
Orphan claim re-pointed
Claims processor
CLM-411449 → UHC-68959-66 (Theresa Perez)
Member id
UHC-68959-66
Confidence
1.00
Method
probabilistic
MBR-007496CLM-411449
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006188
Orphan claim re-pointed
Claims processor
CLM-416752 → UHC-79202-96 (Danielle Garza)
Member id
UHC-79202-96
Confidence
1
Method
probabilistic
MBR-018245CLM-416752
Executed
resolution_agent
2026-10-22 12:47:23
ACT-006189
Orphan claim re-pointed
Claims processor
CLM-424660 → UHC-16910-09 (Joyce Sanchez)
Member id
UHC-16910-09
Confidence
1
Method
probabilistic
MBR-013125CLM-424660
Executed
resolution_agent
2026-10-22 12:47:23
14,086 rows, page 97 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.