Senior AI Engineer — Voice & Agentic Systems

Mira Mace•San Francisco, CA

About The Position

Mira Mace pairs Medicare beneficiaries with a dedicated healthcare advocate who navigates appointments, insurance, and care coordination on their behalf. Our customers get the support of caring nurses while AI agents handle the tedious backend work — all covered by Medicare. We've felt the pain ourselves — the endless back-and-forth with insurance, surprise bills, and the lack of clarity when you just need answers. Too many people fall through the cracks, and we're determined to change that. Today, 24/7 personalized health assistance is only available to the rich or extremely sick. Our vision is for everyone to be able to afford a health assistant who knows your health history deeply, navigates the healthcare system on your behalf, and propels you to become the healthiest version of yourself. Our founding team brings a mix of strong technical experience from companies like Google, Meta, and Amazon, along with serial startup experience ranging from early ventures to Series D scale-ups. We are backed by Foundation Capital, DefineVC and top Silicon Valley angel investors. We're looking for a senior AI engineer who has built voice agents or agentic systems from scratch and shipped them to real users. You'll own the AI layer that powers Mira Mace — from the voice agents our patients interact with to the autonomous workflows that handle insurance navigation, appointment coordination, and care follow-ups behind the scenes. This isn't a role where you'll be handed a spec and asked to implement it. You'll work directly with the founders to figure out what to build, architect the system, and iterate fast based on what's working with real patients. You'll have meaningful ownership of the product and the technical direction of the company. If you've been building voice or agentic AI at a startup and want to apply that experience to a problem that genuinely matters, we'd love to talk.

Requirements

You've built a voice agent or agentic AI system from scratch and shipped it to production — not just a demo, but something handling real conversations with real users.
You have 4+ years of experience as a software or AI engineer, with deep hands-on work in LLMs, prompt engineering, and agent orchestration (LangGraph, custom frameworks, or similar).
You're proficient with the modern voice AI stack using orchestration frameworks (LiveKit).
You write strong production Python and are comfortable with real-time systems, WebSockets, and streaming architectures.
You've monitored and debugged AI systems in production — you know what it takes to keep an agent reliable when it's talking to real people.
You can work across the stack when needed. You don't need a frontend engineer to build an internal dashboard or a DevOps engineer to get something deployed.
You're comfortable with ambiguity. The playbook doesn't exist yet, and you're excited to build it.
You care about doing the right thing for patients, especially when it involves their health, finances, or privacy.

Nice To Haves

Experience in healthcare, health tech, or regulated industries (HIPAA, PHI handling).
Familiarity with Medicare, insurance workflows, or clinical operations.
Contributions to open-source AI projects or a portfolio of side projects that show your range.
Experience with RAG systems, vector databases, and knowledge retrieval pipelines.
Background in evaluation frameworks for LLM-based systems (evals, red-teaming, safety testing).

Responsibilities

Build and own the voice AI system. Design, develop, and deploy voice agents that interact with patients naturally — handling intake calls, appointment reminders, medication check-ins, and care navigation. You'll manage the full pipeline: speech-to-text, LLM reasoning, text-to-speech, and real-time orchestration.
Architect agentic workflows for healthcare operations. Build autonomous agents that handle the tedious backend work our nurses shouldn't have to — insurance verification, prior authorizations, claims follow-ups, and care coordination tasks. Design multi-step workflows that can reason, use tools, and escalate to humans when needed.
Ship fast and iterate with real users. Deploy to production, monitor how agents perform with actual patients, and improve based on real conversations. You'll own the feedback loop from call recordings to prompt improvements to system-level changes.
Build the evaluation and safety layer. Healthcare AI needs to be right. Establish evaluation frameworks, quality metrics, and guardrails so our agents are reliable, safe, and trustworthy with sensitive health information.
Shape the technical roadmap. Work with the founders to decide what to build next. You'll bring deep knowledge of what's possible with current AI capabilities and help us make smart bets on where the technology is heading.
Lay the foundation for scale. Make architectural decisions that will hold up as we grow from hundreds of patients to hundreds of thousands. Document systems, establish best practices, and build with the next engineer in mind.

Benefits

Mission with massive impact. We're not just improving healthcare — we're transforming patient outcomes at scale. Every system you build puts a dedicated health advocate in someone's corner. We're building one of the largest AI-first companies in healthcare, and this is your chance to own the technical foundation from day one.
High ownership. You'll shape the AI architecture, the voice experience, and the agentic systems that power the entire product. This isn't a feature team — it's the core of what we do.
Learn fast, build fast. We believe in experimentation, measurement, and steady improvement. You'll ship every week, not every quarter.
Grow with us. You'll be part of the team that takes Mira Mace from early product to scale. The decisions you make now will define the company's technical DNA.
Meaningful early equity. This is a full-time role with competitive compensation and real ownership in what we're building.

Stand Out From the Crowd

Upload your resume and get instant feedback on how well it matches this job.

Upload and Match Resume