Founding Engineer

About the Role

Join an early-stage healthtech team as its backend-leaning Founding Engineer. You will own core platform architecture and build reliable systems that support medication pricing, claims processing, and payments.

What You'll Do

• Own backend APIs, database design, permissions, sensitive health data boundaries, backups, staging, observability, and deployments.

• Build and operate a real-time drug pricing system that gathers prices from multiple sources and routes claims to the lowest-cost option.

• Manage eligibility and claims workflows connected to an adjudication engine, where reliability is essential for patients accessing medication.

• Build a claims adjudication engine and compare its results with an existing system using replayed claims.

• Own payment flows between brokers, the platform, and pharmacies, with demanding uptime and financial accuracy requirements.

• Make architecture and schema decisions that support growth from hundreds to tens of thousands of users.

What We're Looking For

• Three to eight years of backend or full-stack engineering experience, with strong backend, system architecture, and database schema design skills.

• Experience operating production systems where downtime or errors directly affect revenue, ideally in payments, ledgers, trading, or critical infrastructure.

• Proficiency with Python, FastAPI, PostgreSQL, row-level security, GCP, Cloud Run, Cloud SQL, React, and TypeScript.

• Experience at an early-stage startup, including operating as a sole engineer, and exposure to larger technology organizations.

• Comfort making architecture decisions, using AI development tools such as Claude Code or Cursor, and constructively challenging technical decisions.

• Experience outside healthcare, health benefits, and pharmacy; strong computer science fundamentals are valued.

Compensation & Benefits

Base salary: $210,000 to $260,000 annually. Visa sponsorship is not available.

Location

On-site in New York, New York.