Claims Adjudication Tune-Up (CAT-U)
August Edition
Welcome to Self-Insurance’s (SI) Claims Adjudication Tune-Up (CAT-U) newsletter. This is where the Washington State Department of Labor & Industries (L&I) shares best practices and information, as well as highlight opportunities for improvement. The focus of this month’s CAT-U is Claims Administrator Onboarding and Certification.
Legal Corner
Washington Administrative Code (WAC) 296-15-360 “Qualifications of Personnel – Certified Claim Administrators”
(2) How do I become a certified claims administrator for self-insured claims?
a. Under the mentorship of a certified claims administrator, have a minimum
of one year of experience in the administration or oversight of claims under
Title 51 RCW…
b. Have completed … A comprehensive goal-oriented curriculum approved
by the department and resulting in a worker's compensation professional
designation…
c. Take and pass the department's "self-insurance claims administrator"
test….
(6) How does a certified claims administrator maintain their certified status? A
certified claims administrator may maintain certified status by earning the
required continuing education credits as outlined in this subsection.
a. You must earn forty-five credits every three years…
iv. The forty-five credits must include any training designated as
mandatory by the department … If you fail to earn sufficient continuing
education credits, you will be required to retake the written test to
maintain your certified status.
Take away: Maintaining a staff of certified claim administrators (a.k.a. claim managers) is the responsibility of the self-insured employer or third-party administrator. However, earning and maintaining certification is the responsibility of the individual claim manager.
If you’re just getting started as a trainee, you’ll likely have a lot you’ll need to do in the upcoming days, weeks, and months. If you’re an employer or a third-party administrator, you’ll need to help your new trainee on their path to certification.
Once certified, the claim manager maintains their certification by earning 45 continuing education credits every three years. Certification and the ability to handle claims will expire if this requirement is not met, and the claims administrator will be required to pass the written test again to reinstate their certification.
Onboarding Best Practices
Getting the right start after being hired is crucial to successful training and certification. Here are some tips to help a newly hired claim manager get started and stay on track during training:
- Create a Secure Access Washington (SAW) account, if you don’t already have one. To check, go to the SAW login page. The SAW is a single sign-on portal that grants secure access to all Washington state agencies.
- Don’t create more than one SAW account.
- Use your personal contact information, not work information, when applying for an account. Should you change employers, this will ensure you still receive emails sent by the SAW system.
- Create a Self-Insurance Claims Administrators Tracking System (SI-CATS) account. This is the department account you will use to track continuing education credits, update your current employer, and your contact information. To create your SI-CATS account:
- Log in to your SAW account. If you do not already see SI-CATS listed in the services available, add it by selecting the Add a New Service button and browsing for “Self-Insurance Claims” on the next page. Note: “SI-CATS for Self-Insured TPAs” is not for individual claim administrators. Do not select it if you are a claim administrator trainee.
- Use personal contact information, not work information. Should you change employers, this will ensure you still receive emails sent to the SI-CATS address.
- Once you’ve signed up for SI-CATS, you’ll access it through the My L&I page.
- Sign up as soon as possible for the Goal-Oriented Core Curriculum if you’re not already certified.
- Sign up for GovDelivery to stay informed of what’s new in Self-Insurance.
- Make sure you know who your employer-assigned mentor is as soon as possible. Under WAC 296-15-350(2)(c), employers are required to ensure that mentoring is provided by a certified claims administrator. Remember, a trainee claim administrator cannot manage claims without one.
If you have questions about becoming certified or maintaining certification, please contact the Self-Insurance program at SIcontedu@Lni.wa.gov.
Trainer Trivia
Last month’s question was: “On July 15, 1916, the Boeing Company was established in Washington. What was its original name?”
Answer: Pacific Aero Products Company. There have been several name changes since then, including “The Boeing Airplane and Transport Corporation,” and “United Aircraft and Transport Corporation,” before settling on the current name, “The Boeing Company”.
August Question: In 1859, the United States and Britain almost went to war over the northwest U.S. boundary because of what animal?
More reading/resources:
L&I Self-Insurance Training Page: more information about the continuing education program, email bulletins, and credit reporting.
Self-Insurance Claim Adjudication Guidelines, Management of Claims Chapter.
Reminders/tips from the SI teams:
Effective Mentorship tips: The mentor’s role is to be a point person for the trainee. A mentor doesn’t have to know the answer to every question, but should be able to direct trainees to subject matter experts, and resources like the Self-Insurance Claim Adjudication Guidelines. They should also provide constructive feedback to the trainee regarding areas of improvement, which can be identified through work checking, practice exercises, and quizzes or knowledge checks.
For more information, email: SITrainerQuestions@Lni.wa.gov
Claims Adjudication Tune-Up (CAT-U)
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