Founding Engineer

About the Role

Join an early-stage healthtech company as a backend-leaning Founding Engineer. You will own core engineering systems that support real-time prescription pricing, claims processing, and reliable payments, helping ensure patients can access their medication.

What You'll Do

• Own the backend, including APIs, database design, permissions, protected health information 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 the lowest-cost option.

• Manage eligibility and claims flowing through an adjudication engine, keeping failures from disrupting pharmacy transactions.

• Build a claims adjudication engine and validate it against the existing system using replayed real claims.

• Develop and maintain payment infrastructure for payments between brokers, the platform, and pharmacies.

• 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 and system architecture skills.

• Experience building and operating production systems where errors or downtime 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.

• Experience making database schema and architecture decisions, ideally as a sole engineer at an early-stage startup.

• Comfort challenging technical decisions and communicating directly with a strong-opinioned founder.

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

• Startup experience alongside larger-company experience is valuable. Experience outside healthcare, health benefits, and pharmacy is required.

Compensation & Benefits

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

Location

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