Founding Engineer

About the Role

Join an early-stage healthtech team as its backend-leaning Founding Engineer. You will own core platform architecture and build reliable systems that support prescription pricing, claims processing, and payments.

What You'll Do

• Own the backend, including APIs, database design, permissions, sensitive health data 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 cost-effective options.

• Manage eligibility and claims flows through an adjudication engine, ensuring failures do not disrupt access to medication.

• Build a claims adjudication engine and validate it against a current system using replayed claims.

• Own payment infrastructure between brokers and pharmacies, with high availability and financial accuracy requirements.

• Make foundational architecture and schema decisions as the platform scales.

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 building and operating production systems where downtime or errors 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.

• Familiarity with AI development tools such as Claude Code or Cursor.

• Comfort operating as the sole engineer at an early-stage startup, making architecture decisions, and constructively challenging technical assumptions.

• Startup experience alongside experience in larger technology organizations is valued. Experience in healthcare, health benefits, or pharmacy is not required.

Compensation & Benefits

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

Location

On-site in New York, New York.