Founding Engineer, Backend & Infra

Backbone Systems•San Francisco, CA

About The Position

About Backbone Backbone Care should be paid for the moment it’s delivered. At Backbone, we’re making that possible for the first time by building the clinical AI layer for healthcare payments. Today, U.S. healthcare wastes more than $350B yearly on administrative work that has nothing to do with patient care: prior authorizations, denials, appeals, and the staff hired on both sides of the aisle to adjudicate and determine payment for services rendered. As a result, patient care is delayed, clinicians burn out, margins crater, and hundreds of billions of dollars that should be funding care end up funding the friction itself. Backbone is dismantling this friction, building intelligent financial rails atop clinical AI research to facilitate instant payments between payers and providers. We're backed by Andreessen Horowitz (a16z), Lightspeed, Hanabi, and a roster of operators and clinicians who have built and run the largest payers, providers, and healthcare technology platforms in the country. Our founder/CEO, Manan Shah, holds a BS/MS in Math & CS from Stanford and led ML infrastructure at Sequoia-backed Kumo AI, where he built graph neural networks serving DoorDash, Reddit, and Coinbase. Backbone’s revenue is growing quickly, customer demand is outpacing our team, and the road ahead is bright.

Requirements

3+ years of professional software engineering experience shipping production systems end-to-end
Generalist range across backend, data, and ML, alongside real LLM experience in production
Comfort with distributed systems, microservices, queues, workflow engines, data pipelines, or large-scale backend infrastructure

Nice To Haves

Healthcare experience is helpful, but not required. Curiosity, rigor, and taste matter more.

Responsibilities

Build and scale the distributed systems that power Backbone’s clinical and financial workflow; own backend services across chart data, claims data, authorization workflows, denial workflows, and payer/provider integrations
Build orchestration infrastructure for long-running, failure-prone workflows across EHRs, practice management systems, clearinghouses, and payer portals
Work on browser-use and computer-use systems that navigate complex medical software and payer portals
Design reliable systems for messy healthcare data: scanned charts, PDFs, structured claims, unstructured notes, attachments, policies, and operational state
Build observability, retry, audit, and human-in-the-loop infrastructure for high-stakes production workflows
Partner with product and research engineers to take new clinical intelligence capabilities into production, and set the engineering patterns that future engineers will inherit