Founding Engineer

ABOUT THE ROLE Join an early-stage healthtech company as its backend-leaning Founding Engineer. You will own core platform engineering across claims, pricing, and payments, helping ensure people can access their medications reliably. WHAT YOU'LL DO - Own backend APIs, database design, permissions, PHI boundaries, backups, staging, observability, and deployments. - Build and operate a real-time drug pricing system that regularly gathers prices from multiple sources and routes claims to cost-effective options. - Manage eligibility and claims workflows with a focus on reliability and uninterrupted pharmacy transactions. - Build a claims adjudication engine and validate it against an existing system using replayed claims. - Develop payment infrastructure connecting brokers and pharmacies, with high availability and financial accuracy requirements. - 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 architecture and database schema design skills. - Experience building and operating production systems where downtime or errors directly affect revenue, such as payments, ledgers, trading, or critical infrastructure. - Comfort working as a sole engineer at an early-stage startup, making architecture decisions, and constructively challenging technical direction. - Proficiency with Python, FastAPI, PostgreSQL, row-level security, GCP, Cloud Run, Cloud SQL, React, and TypeScript. - Experience using AI development tools such as Claude Code or Cursor. - Startup experience, including work outside healthcare, health benefits, and pharmacy. Strong computer science fundamentals are valued. - Must be authorized to work in the United States without 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.