Founding Engineer
Summary
Backend-leaning founding engineer at an early-stage healthtech startup, owning the systems behind real-time drug pricing, claims adjudication, and payments between brokers, pharmacies, and the platform. Day-to-day is backend API, database, and infrastructure work in Python/FastAPI and PostgreSQL on GCP, with some React/TypeScript.
About the Role
Join an early-stage healthtech team as its backend-leaning Founding Engineer. You will own core engineering systems that support real-time drug pricing, claims processing, and payments, helping ensure people can access their medication reliably.
What You'll Do
Own backend 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 competitive options.
Manage eligibility and claims workflows connected to an adjudication engine, with a focus on reliable processing.
Build a claims adjudication engine and validate its behavior against an existing system using replayed claims.
Develop payment infrastructure for transactions between brokers, the platform, and pharmacies.
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 experience as a backend or full-stack engineer, with strong backend, architecture, and database schema skills.
Experience building and operating production systems where errors or downtime affect revenue, such as payments, ledgers, trading, or critical infrastructure.
Proficiency with Python, FastAPI, PostgreSQL, row-level security, GCP, Cloud Run, Cloud SQL, React, TypeScript, and AI development tools such as Claude Code or Cursor.
Startup experience, ideally including work as a sole engineer at an early-stage company, and the judgment to make and challenge architectural decisions.
Experience outside healthcare, health benefits, and pharmacy is required; fintech or infrastructure experience and a computer science or related degree are helpful.
Must be authorized to work without employer visa sponsorship.
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.
Skills
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