Founding Engineer

About the Role

Join an early-stage healthtech team as a backend-leaning Founding Engineer, owning the core platform and its architecture. Your work will support reliable medication pricing, claims processing, and payments where accuracy and uptime directly affect patients and pharmacies.

What You'll Do

• Own backend APIs, database design, permissions, privacy 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, and build an in-house engine validated against replayed real claims.

• Own payment infrastructure between brokers and pharmacies, with stringent reliability 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 errors or downtime 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 using AI development tools such as Claude Code or Cursor.

• Comfort operating as a sole engineer at an early-stage startup, making scaling decisions, and constructively challenging technical direction.

• Startup experience alongside experience in larger technology organizations is valued. Experience outside healthcare, health benefits, and pharmacy is required.

Compensation & Benefits

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

Location

On-site in New York, New York, United States.