The World Trade Center Health Program (WTCHP) is a limited benefit health plan for eligible responders and survivors of the September 11, 2001, WTC attacks. Since 2016, our teams on the World Trade Center (WTC) Health Program Support (HPS) contract provide labor, systems, and support services across Program, Quality, and Data Management, as well as day-to-day operational support across member services, provider network management, medical management, health plan finance, claims adjudication, and Call Center. This work is facilitated by four skilled, dedicated teams with one collective goal: to help evolve WTCHP operations to improve service to WTC beneficiaries and stakeholders.
And we’re shining the spotlight on them! Learn more about each team and their members here:
Member Services
Karna’s Member Services team is comprised of the Enrollment Team & the Certification Team. The enrollment team receives, reviews, and enters applications for eligible survivors and responders. They also send completed applications for approval and/or denial recommendations to the client and maintain correspondence for the WTCHP call center, members, and applicants. The certification team processes medical health condition certification applications, sends approval and/or denial recommendations to the client, and handles communication with internal and external parties regarding the status of their certifications.
“I like working with my Karna team because we all collaborate well with one another. This is the only job that wants each other to succeed, whether within the company or moving somewhere that you think is better for you. Karna is always having activities and courses that help us with skill-building. I also love that Karna believes in work-life balance, which takes a load off to make the work environment less stressful.”
“I thoroughly enjoy being a part of the Karna Member Services Team. I have had an opportunity to learn, grow, and expand my knowledge about the World Trade Center events. To know that you are helping people who are a part of living history is very rewarding.”
Claims Operations
Karna’s Claims Operations team diligently processes claims for individuals affected by the 911 incident on September 11, 2001. Within their purview is the processing of professional, institutional, and dental claims for responders and survivors of the event. As part of claims adjudication, our internal partners, Medical Management, Enrollment, Member Services, and Provider areas, work closely with the claims team to address a spectrum of issues such as medical necessity, member eligibility, customer service inquiries, or updates to provider files. The claims team maintains a robust line of communication with our external partners, the Clinical Centers of Excellence (CCEs), clients, and healthcare providers to address claims-related inquiries.
Pictured in the Header Photo (from left): Michelle Martin, Carolyn Lofton (claims processors), Adeline Lee (Auditor), Rosalyn Reeves (processor), and Marjorie Peters (Sr. Claims Team Lead).
“I have been with the World Trade Center Claims Team for five years. I’ve had the opportunity to learn, grow, and move up with more responsibilities. Everyone here is willing to offer their time, resources, and knowledge to help you further your future.”
Anunca Ashley, WTC Claims Team Lead“I love working for Karna and the claims team because there was a sense of real work-life balance from day one. I applied because I love claims processing, but I soon learned this was not the typical claims job where metrics were the only goal. The Karna claims management team makes it clear that quality and processing claims correctly the first time is of the utmost importance. There are faces and lives behind each claim, and remember that our members deserve our best daily. I feel a sense of pride and honor to be a part of the WTCHP claims team.”
Charmaine Young, WTC Claims Processor“Working for Karna, LLC on the World Trade Center Health Program (WTCHP) has been the most rewarding position of my professional career. Our responders and survivors were part of an incident that placed them in a harmful situation, which has produced physical conditions that will continue to be constant reminders of a dark period in their lives. It is my humble privilege to give all that I have daily to members of our country, who have given me much more than I could ever repay. It has always been my mantra to “Leave People Better Than I Found Them,” and in some small way, I hope that I am making a meaningful difference in the lives of our members.”
Selina Robinson , WTC Sr. Claims Operations ManagerProvider
Karna’s Provider team is responsible for all provider contracting and education. This includes working with the client to add providers to the program as beneficiaries and stakeholders request them. Most recently, a big push was to add Home Health, Acupuncture, and Mental Health providers to the program. Due to this push, the team added numerous Mental Health providers and continues working to add additional Home Health and Acupuncture providers. Not only does the Provider Team work closely with the client, but also with HealthSmart and the Karna Claims team.
“I am really proud of how Karna has evolved the provider enrollment services support over the years to incorporate a strong provider outreach component, wherein relationships are established with the WTCHP provider community beyond simply a network registration. Maintaining open and reciprocal communication with the providers ultimately serves to assist our member community because we can identify and address network specialty needs more quickly, learn about the challenges the providers may be experiencing across the care management, policy, and reimbursement spectrum, and develop focused communications to educate the affected providers accordingly. I appreciate that my role requires fundamental knowledge of all operational areas because we are a direct source of support and guidance for our provider community!”
Emily Pedrozo, Provider Team Member“I feel that the World Trade Center Health Program is so important to this population that I have been working for our members and providers for over five years and two different companies. The team here at Karna shares in my enthusiasm and drive to provide the best service to our members and provider network. I am glad to come to work every day and be part of this team!”
Chad Hoffman, Provider Team Member“It’s rare to be proud of your job. Typically, a job is just a job, but the World Trade Center Health Program is truly something I’m proud to be a part of. A GREAT program and a GREAT team.”
John Urbank, Provider Team MemberMedical Management
Karna’s Medical Management team makes policy recommendations to the client and maintains the WTC Health Program’s pricing methodologies. The team conducts post-utilization audits to ensure policy compliance and avoid fraud, waste, and abuse. They review all medical code requests and maintain the Program’s Codebooks. In addition, the team resolves claims issues for claims pending medical review and reviews all prior authorization requests.
Brenda Sedo
Doris Greggs-McQuilkin
Jill Wilson
Lila Prado
Natalie Sirois
