Claim Administrator Certification FAQs

How do I become a certified claim administrator for self-insured employers?

To become a certified claim administrator for self-insured employers, you must:

• Have been under the mentorship of a certified claim administrator.
• Have a minimum of 1 year work experience in the administration or oversight of claims under Title 51 in the 5 years prior to taking the certification test.
• Have completed comprehensive goal-oriented curriculum approved by L&I and resulting in a worker’s compensation professional designation, or taken an approved training program within the department.
• Take and pass the self-insurance claim administrator test.
Who must become certified claims administrator?

Persons “making claim decisions" must become certified claims administrators, those include:

• People who manage claims directly.
• People who request to allow or deny claims under WAC 296-15-420.
• People who take action on claims under WAC 296-15-425.
• People who manage operations indirectly in support of claim administrators, such as human resources, accounting, or executive management, do not need to be a certified claim administrator.
What happens if I fail the self-insurance claim administrator test?

You may retest after the failed test. The 6-month waiting period was removed from WAC 296-15-360.

I am concerned about COVID-19 and taking an in-person test at L&I. Is the self-insurance claim administrator test offered electronically?

Yes. An online test has been available since June 2021.

Do medical only claim administrators need to become certified?

Yes. Every person making claim decisions for Washington state self-insured employers must be a certified claim administrator or in the process of obtaining their certification. This includes medical only and time-loss claim administrators contracted to handle claims for self-insured employers.

I am located out of state and manage claims for self-insured employers located in Washington state. Do I need to become a certified claim administrator?

Yes. Every person making claim decisions for Washington state self-insured employers must be a certified claim administrators or in the process of obtaining their certification, including those persons who are located out of state.

I manage claims for self-administered employers. Do I need to become a certified claim administrator?

Yes. Every person making claims decisions for Washington state self-insured employers must be a certified claim administrators or in the process of obtaining their certification. This includes claim administrators who work for self-administered employers.

I manage state fund claims at a third-party administrator. Do I need to become a certified claim administrator?

No. A claim administrator who manages state fund claims does not need to be a certified claim administrator. This new law applies only to claim administrators contracted to manage claims for self-insured employers.

I manage claims for a retro group at a third-party administrator. Do I need to become a certified claim administrator?

No. A claim administrator who manages state fund claims in a retro group does not need to be a certified claim administrator. This new law applies only to claim administrators contracted to manage claims for self-insured employers.

I am a medical provider or a third-party biller who works with clients with self-insured employers. Do I need to become a certified claim administrator and does my business need to be licensed to handle self-insured employer’s medical bills?

No on both. Medical providers and third-party medical billers do not need to be become certified claim administrators, and their business does not require a TPA license. The new law only applies to claim administrators contracted to manage claims for self-insured employers.