Founding Engineer
Summary
Backend-leaning founding engineer at an early-stage healthtech startup, owning the core platform for medication pricing, claims adjudication, and pharmacy payment infrastructure. Day-to-day involves building APIs, database schemas, and real-time pricing/claims systems with Python, FastAPI, PostgreSQL, GCP, React, and TypeScript.
About the Role
Join an early-stage healthtech team as a backend-leaning Founding Engineer. You will own core platform engineering, building reliable systems for medication pricing, claims, and payments where correctness and uptime directly affect people's access to medication.
What You'll Do
Own the backend, including APIs, database design, permissions, sensitive-data boundaries, backups, staging, observability, and deployments.
Build and operate a real-time medication pricing system that gathers prices from multiple sources and routes claims to cost-effective options.
Manage eligibility and claims workflows connected to an adjudication engine.
Build a claims adjudication engine and validate it against the existing system using replayed claims.
Develop and operate payment infrastructure connecting brokers and pharmacies, with stringent reliability requirements.
Make foundational architecture and schema decisions to support growth from hundreds to tens of thousands of users and beyond.
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 errors or downtime have a 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 using AI development tools such as Claude Code or Cursor.
Comfort operating as a sole engineer in an early-stage startup, making architecture decisions, and constructively challenging technical direction.
Startup experience alongside experience in larger technology organizations is valued. Experience in fintech or infrastructure is a plus.
Strong computer science fundamentals are valued. Experience outside healthcare, health benefits, and pharmacy is required.
Compensation & Benefits
Base salary: $210,000 to $260,000 USD annually. Visa sponsorship is not available.
Location
On-site in New York, United States.
Skills
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