Founding Engineer

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.

• 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.

On-site in New York, New York.

• 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.

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