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About the Role

As a founding engineer, you will own the systems that make Backbone work, including chart ingestion, document processing, claims workflows, browser and computer-use automation, payer portal navigation, orchestration, queues, reliability, auditability, and the infrastructure needed to scale from thousands of charts and claims to hundreds of thousands.

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

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

Experience Level

• 3+ years of professional software engineering experience

Benefits

• Competitive compensation
• Meaningful ownership

About the Company

• 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.