Founding Engineer, Backend & Infra

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.

As a founding engineer, you’ll own the systems that make Backbone work: 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.

You will:

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