Product Engineer

About Backbone

Care should be paid for the moment it’s delivered.

At Backbone, we’re building the clinical AI layer for healthcare payments: software that helps payers and providers move from slow, manual adjudication to faster, more reliable financial workflows.

Today, U.S. healthcare wastes more than $350B every year on administrative work that has little to do with patient care: prior authorizations, benefits checks, denials, appeals, medical necessity review, and the staff hired on both sides to determine whether care should be paid for. The result is delayed care, burned-out clinicians, strained margins, and hundreds of billions of dollars funding friction instead of care.

Backbone is dismantling that friction. We build systems that reason over clinical records, payer policies, PDFs, portals, and operational workflows to help healthcare organizations make payment decisions faster and more accurately.

We’re backed by Andreessen Horowitz, Lightspeed, Hanabi, and leading operators and clinicians across healthcare and technology. Our founder/CEO, Manan Shah, previously led ML infrastructure at Sequoia-backed Kumo AI, where he built graph neural networks serving companies like DoorDash, Reddit, and Coinbase.

Revenue is growing quickly, customer demand is outpacing the team, and we’re hiring early product engineers to help build the core product.

Why we need you

We’re looking for a Product Engineer who wants to own hard, ambiguous problems end-to-end.

This is not a narrow frontend role or a backend ticket queue. You’ll sit close to customers, understand where healthcare operations break down, and turn messy workflows into reliable product. One week you might be building a React interface for prior authorization review; the next, designing a Python pipeline for long-running PDF parsing jobs; the next, debugging edge cases in clinical reasoning or payer-policy matching.

The right person is a high-slope generalist: strong enough technically to build production systems, curious enough to understand healthcare workflows, and product-minded enough to care deeply about whether users can actually get their work done.

What you’ll do

• Own product surfaces end-to-end, from ambiguous customer problem to production feature

• Build React and TypeScript workflows for healthcare teams reviewing authorizations, benefits, payer rules, clinical documentation, and denials

• Design Python backend systems for document processing, data extraction, workflow automation, and clinical reasoning

• Build infrastructure for long-running parsing and reasoning tasks over PDFs, medical records, payer policies, and portal-driven workflows

• Work directly with customers to understand operational nuance and translate it into product

• Build evals, benchmarks, and observability that help us ship safely in a domain where correctness matters

• Help define the architecture, engineering practices, and product judgment that future engineers will inherit

What we’re looking for

You might be a fit if you:

• Have strong full-stack engineering ability, especially across React, TypeScript, Python, APIs, data models, and backend systems

• Like building product, not just writing code

• Are comfortable with messy, real-world systems: unstructured data, PDFs, edge cases, long-running jobs, integrations, and humans in the loop

• Care about correctness, reliability, and operational detail

• Want to talk to users, watch workflows break, and bring that context back into the product

• Have high judgment: you can make progress with incomplete information, ask for help when stuck, and push back when something feels wrong

• Want the ownership and intensity of an early-stage startup

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

Bonus points

Experience with any of the following is especially useful:

• Document parsing, OCR, PDF processing, information extraction, or retrieval systems

• LLMs, NLP, ML infrastructure, or eval systems in production

• Workflow automation, internal tools, or operational software

• Queue-based systems, background jobs, distributed processing, or event-driven architecture

• Healthcare, insurance, revenue cycle, prior authorization, benefits investigation, claims, or EHR/EMR integrations

• Early-stage startups or high-ownership engineering environments

Why join

This is a rare chance to join early and build foundational technology in a massive, broken, high-impact industry.

You’ll work on problems where the stakes are real: delayed care, denied claims, provider burnout, and billions of dollars lost to administrative friction. You’ll help define not just features, but the product, architecture, and engineering culture of Backbone.

We offer highly competitive compensation, meaningful early-stage equity, and the opportunity to build category-defining infrastructure at the intersection of clinical AI, healthcare payments, and real-world operations.