Founding Engineer
Summary
Backend-leaning founding engineer at an early-stage healthtech startup, on-site in New York, owning APIs, database design, and infrastructure for a real-time drug pricing, claims adjudication, and payments platform. Core stack: Python, FastAPI, PostgreSQL, GCP, React, TypeScript.
About the Role
Join an early-stage healthtech team as its backend-leaning Founding Engineer. You will own core systems for drug pricing, claims, and payments, helping ensure reliable access to medication while shaping the platform's technical foundations.
What You'll Do
Own backend APIs, database design, permissions, health data boundaries, backups, staging, observability, and deployments.
Build and operate a real-time drug pricing system that collects prices from multiple sources and routes claims to the lowest-cost option.
Manage eligibility and claims flows through the adjudication system, maintaining reliability for pharmacy transactions.
Build a claims adjudication engine and validate it against an existing system using replayed claims.
Develop payments infrastructure for broker and pharmacy transactions, supporting high availability and significant payment flows.
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 backend or full-stack engineering experience, with strong backend architecture and database schema design skills.
Experience owning production systems where downtime or errors 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 operating as a sole engineer or taking broad ownership at an early-stage startup, alongside exposure to larger technology organizations.
Comfort making architecture decisions, working with AI development tools such as Claude Code or Cursor, and constructively challenging technical direction.
Experience outside healthcare, health benefits, and pharmacy is preferred. 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.
Skills
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