As a workers’ compensation insurance carrier in California, State Compensation Insurance Fund is subject to compliance and regulations to have all claims adjusters and medical bill reviewers certified in their roles with oversight by the California Department of Insurance (CDI). Regulations require newly appointed claims adjusters to have a minimum of 120 hours of classroom instruction and 40 hours of on-the-job training to be certified.
Basic Adjuster Training (BAT), the previous version of State Fund’s new adjuster certification training, originally was developed in 2006, and was composed mostly of reading manuals, lectures, and classroom exercises taught by experienced instructors employed at State Fund. Most often, newly hired claims adjusters would complete their training feeling overwhelmed, anxious, and not able to take on full caseloads for several months, and, in fact, did not reach a level of competence and independence for 18 to 24 months.
In 2015, State Fund’s Learning & Organizational Development (L&OD) department began the task of overhauling the complete adjuster training program to be more in line with a 70:20:10 model of 70 percent of learning on the job, 20 percent of learning from others in coaching or mentoring relationships, and 10 percent of learning through formal training in the classroom. The focus was on core concepts and how to get started in their new role.
In June 2016, State Fund’s L&OD department launched the train-the-trainer of the new adjuster training program: Adjuster Certification Training (ACT).
Program Details
Instead of focusing on meeting the regulatory hours, the new program focuses more on teaching a claims adjuster how to perform his or her job and where to find answers to questions after the training. The new program is now 167 classroom hours, with learners spending less time hearing lectures and more time in collaboration, group activities, and learning from others. Additional training hours within the program include 61.5 hours of on-the-job training and 36 hours of hands-on experience, where the new claims adjuster is handling a small caseload while still participating in training so he or she can immediately apply newly learned concepts, which will reduce the forgetting curve.
Results
While the program is still fairly new, the Claims Training personnel at State Fund have indicated the new ACT for claims adjusters is a success. Claims adjusters are managing claims much faster and are able to work independently; surveys of claims managers indicate that new adjusters are effective and independent in 12 to 18 months, a 25 to 50 percent reduction in the time to reach this level under the prior training plan.
This new training program for claims adjusters also is helping the Claims department to meet the enterprise goal of improving claims efficiencies with reduced errors for claims adjusters, improved quality for injured workers, and reduced medical costs for the life a claim. Since the implementation of ACT, penalties have decreased by 19 percent.
