Founding Engineer
Confirmed on the employer's own hiring board on Nov 12, 2026. First seen by Alion on Nov 12, 2026.
About the Role
Join an early-stage healthtech company as a backend-leaning Founding Engineer. You will own core engineering systems that support real-time prescription pricing, claims processing, and reliable payments, helping ensure patients can access their medication.
What You'll Do
Own the backend, including APIs, database design, permissions, protected health information 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 flowing through an adjudication engine, keeping failures from disrupting pharmacy transactions.
Build a claims adjudication engine and validate it against the existing system using replayed real claims.
Develop and maintain payment infrastructure for payments between brokers, the platform, and pharmacies.
Make architecture and schema decisions that support growth from hundreds to tens of thousands of users and beyond.
What We're Looking For
Three to eight years of experience as a backend or full-stack engineer, with strong backend and system architecture skills.
Experience building and operating production systems where errors or downtime have direct financial or operational impact, such as payments, ledgers, trading, or critical infrastructure.
Proficiency with Python, FastAPI, PostgreSQL, row-level security, GCP, Cloud Run, Cloud SQL, React, and TypeScript.
Experience making database schema and architecture decisions, ideally as a sole engineer at an early-stage startup.
Comfort challenging technical decisions and communicating directly with a strong-opinioned founder.
Familiarity with AI development tools such as Claude Code or Cursor.
Startup experience alongside larger-company experience is valuable. Experience outside healthcare, health benefits, and pharmacy is required.
Compensation & Benefits
Base salary: $210,000 to $260,000 annually. Visa sponsorship is not available.
Location
On-site in New York, New York, United States.