Founding Engineer

About the Role

Join an early-stage healthtech team as its backend-leaning Founding Engineer. You will own core systems for drug pricing, claims, and payments, helping ensure reliable access to medication while shaping the platform's technical foundations.

What You'll Do

• Own backend APIs, database design, permissions, health data boundaries, backups, staging, observability, and deployments.
• Build and operate a real-time drug pricing system that collects prices from multiple sources and routes claims to the lowest-cost option.
• Manage eligibility and claims flows through the adjudication system, maintaining reliability for pharmacy transactions.
• Build a claims adjudication engine and validate it against an existing system using replayed claims.
• Develop payments infrastructure for broker and pharmacy transactions, supporting high availability and significant payment flows.
• 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 backend or full-stack engineering experience, with strong backend architecture and database schema design skills.
• Experience owning production systems where downtime or errors have direct financial or operational consequences, 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 operating as a sole engineer or taking broad ownership at an early-stage startup, alongside exposure to larger technology organizations.
• Comfort making architecture decisions, working with AI development tools such as Claude Code or Cursor, and constructively challenging technical direction.
• Experience outside healthcare, health benefits, and pharmacy is preferred. A computer science or related degree is a plus.

Compensation & Benefits

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

Location

On-site in New York, New York.