Senior Backend Engineer

What You’ll Do

• Architect Healthcare Commerce: Build and evolve a subscription and billing infrastructure that handles the messy reality of healthcare. Solve for mid-cycle medication switches, dynamic pricing across different pharmacy partners, payment recovery, and prorated billing.
• Build Clinical State Machines: Own the systems that power complex medication ordering and fulfillment. Build highly reliable pipelines that handle compounding pharmacy integrations, controlled substance compliance, and personalized dosing protocols across a distributed network of external partners.
• Own the Infrastructure: Take hands-on ownership of the AWS and Kubernetes infrastructure that runs your services. Establish CI/CD pipelines, build observability, and create deployment patterns that make it safe for the entire team to ship rapidly.
• Act as a Product Partner: Work directly with Clinical, Operations, and Product teams to shape what we build. Evaluate proposed workflows, take ownership of business outcomes, and actively identify paths to deliver maximum patient value with highly efficient implementation.
• Build Agentic Workflows: Design the backend architecture that allows AI-assisted agents to automate clinical operations, improve patient safety, and scale our provider workflows. Utilize frontier agentic models to accelerate your own development.
• Raise the Engineering Bar: Own key architectural decisions, systematically upgrade legacy systems, and elevate the engineers around you through rigorous code review, testing practices, and technical standards.

Who You Are

• 5-7+ years of backend engineering experience building and operating production systems that handle real complexity (complex domain logic, distributed stateful workflows, and deep integrations with external partners).
• Strong data modeling skills with careful attention to schema design, state transitions, and domain boundaries.
• Comfortable with (or eager to master) Kubernetes, Terraform, AWS, and CI/CD; view deploying your own code and owning your system's reliability as a fundamental part of backend engineering.
• Already using frontier agentic tools (e.g. Codex, Claude) to build faster and can describe specific ways these models have changed how you code, while retaining deep technical skepticism to audit, verify, and own its output.
• Collaborative builder with low ego, high standards, and excellent communication skills. Thrive in cross-functional environments shaped by healthcare regulations, compliance, and patient safety.
• Excited to work in-person 5 days a week in our San Francisco office.

For Staff leveling: demonstrated track record of setting technical direction across teams, navigating deep ambiguity, and measurably leveling up the engineers around you.

Our Stack

TypeScript, Node.js, Express, PostgreSQL, Redis, Kubernetes, Terraform, AWS. Experience with these is a strong plus; we index on engineering fundamentals, distributed systems experience, and domain reasoning.

Compensation & Benefits

• $230,000 - $280,000 (Open to Staff leveling at $280-330K)
• Generous equity packages
• Daily Meals and Espresso Bar
• Pre-Tax Commuter Perks
• 401(k) with match
• Comprehensive Benefits