Founding Engineer
Summary
Founding backend-leaning engineer at an early-stage healthtech startup in New York, owning APIs, database design, a real-time drug pricing system, a claims adjudication engine, and payment infrastructure, built with Python, FastAPI, PostgreSQL, GCP, React, and TypeScript.
About the Role
Join an early-stage healthtech team as its backend-leaning Founding Engineer. You will own core platform engineering, building reliable systems for drug pricing, claims, and payments where accuracy and uptime directly affect access to medication and financial operations.
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 the lowest-cost option.
Manage eligibility and claims flows through an adjudication engine, ensuring failures do not disrupt pharmacy transactions.
Build an in-house claims adjudication engine and validate it against an existing system using replayed claims.
Develop payment infrastructure for broker and pharmacy transactions, with demanding reliability requirements.
Make architecture and data model decisions that support growth from hundreds to tens of thousands of users.
What We're Looking For
Three to eight years of backend or full-stack software engineering experience, with strong backend, architecture, and database schema design skills.
Experience owning production systems where downtime or errors have direct financial 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.
Comfort operating as a sole engineer in an early-stage startup, making independent technical decisions, and constructively challenging technical leadership.
Experience with AI development tools such as Claude Code or Cursor.
Startup experience alongside experience in larger technology organizations is valued. A computer science or related degree is a plus.
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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