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 taking an approved training program within the department.
    • Take and pass the self-insurance claim administrator test.
    I am not a certified claim administrator, but have been managing claims for self-insurance employers for several years. Do I still need to take the self-insurance claim administrator test?

    Yes. You still have to take the test. If you meet the work experience requirement, the requirement for the goal-oriented curriculum is waived until January 1, 2022. Effective January 1, 2022, the completion of the goal-oriented curriculum is required prior to taking the test.

    Effective July 1, 2021, 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. What are “making claim decisions?”

    A person “making claim decisions" 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. The Washington State Department of Labor & Industries (L&I) will begin offering an electronic option for the claim administrator certification test in June of 2021. During the past year, L&I was not able to offer in-person testing due to concerns over the COVID-19 pandemic and the need for social distancing. To allow more time for those who need to take the certification test, L&I will not begin enforcement of the July 1, 2021 requirement for claim administrators to become certified until January 1, 2022.

    For additional information see What's New in Self-Insurance.

    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.