Founding Engineer

ABOUT THE ROLE Join an early-stage healthtech team as its backend-leaning Founding Engineer. You will own core engineering systems that support real-time drug pricing, claims processing, and payments, helping ensure people can access their medication reliably. WHAT YOU'LL DO - Own backend 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 competitive options. - Manage eligibility and claims workflows connected to an adjudication engine, with a focus on reliable processing. - Build a claims adjudication engine and validate its behavior against an existing system using replayed claims. - Develop payment infrastructure for transactions between brokers, the platform, and pharmacies. - Make foundational architecture and schema decisions to support growth from hundreds to tens of thousands of users. WHAT WE'RE LOOKING FOR - Three to eight years of experience as a backend or full-stack engineer, with strong backend, architecture, and database schema skills. - Experience building and operating production systems where errors or downtime affect revenue, such as payments, ledgers, trading, or critical infrastructure. - Proficiency with Python, FastAPI, PostgreSQL, row-level security, GCP, Cloud Run, Cloud SQL, React, TypeScript, and AI development tools such as Claude Code or Cursor. - Startup experience, ideally including work as a sole engineer at an early-stage company, and the judgment to make and challenge architectural decisions. - Experience outside healthcare, health benefits, and pharmacy is required; fintech or infrastructure experience and a computer science or related degree are helpful. - Must be authorized to work without employer visa sponsorship. 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.