Senior / Staff Product Engineer, Founding Team

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 a senior founding engineer to help define the product, architecture, and engineering culture behind Backbone’s next stage.

Why we need you

We’re looking for a senior product engineer who can become one of the technical anchors of the company.

This is not a narrow frontend role, a backend ticket queue, or a pure architecture role. You’ll move fluidly from customer calls to system design to shipping production code. You’ll lead ambiguous, high-stakes product areas where the requirements are buried inside messy healthcare workflows, payer rules, clinical documentation, and operational edge cases.

As one of the earliest senior engineers, you’ll help decide how Backbone’s platform should work, what technical patterns the next five engineers inherit, how we evaluate correctness, and how we ship quickly without losing reliability in a regulated, high-consequence domain.

The right person has already owned meaningful production systems end-to-end and wants the scope of a founding role: architecture, product judgment, customer implementation, code, mentorship, and company-building.

What you’ll do

• Own major parts of Backbone’s platform end-to-end: clinical reasoning systems, integrations, customer-facing workflows, and the data infrastructure underneath

• Lead high-consequence customer implementations, from technical discovery through production go-live and iteration

• Design the architecture that connects Backbone to heterogeneous healthcare systems, payer portals, clinical records, PDFs, and operational workflows

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

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

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

• Establish engineering practices for code review, testing, observability, incident response, and safe deployment in a correctness-sensitive domain

• Work directly with customers to debug live edge cases and translate clinical, financial, and operational nuance into product

• Mentor future engineers, raise the technical bar, and help shape how the engineering team hires and scales

• Ship code on the highest-leverage problems while making architectural decisions that will hold up as the product and team grow

What we’re looking for

You might be a fit if you:

• Have 5+ years of professional software engineering experience, or equivalent evidence of senior-level impact

• Have owned production systems end-to-end across backend services, integrations, customer-facing surfaces, and the operational discipline needed to keep them running

• Have strong system design judgment: you can decompose vague customer pain into coherent systems that other engineers can extend

• Are comfortable across React, TypeScript, Python, APIs, data models, queues, observability, and backend architecture

• Care deeply about correctness, reliability, and product quality, especially in domains where mistakes have real operational consequences

• Want to sit with users, understand where workflows break, and bring that context back into product and architecture

• Know when to move fast, when to slow down, and where technical debt is acceptable versus dangerous

• Communicate clearly, push back thoughtfully, and raise the judgment of the people around you

• Want the ownership, ambiguity, and intensity of an early-stage company

Healthcare experience is helpful, but not required. Strong product judgment, systems taste, and curiosity matter more.

Bonus points

Experience with any of the following is especially useful:

• LLMs, NLP, ML infrastructure, clinical reasoning systems, or eval frameworks in production

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

• Healthcare integrations, EHR/EMR systems, claims, prior authorization, benefits investigation, revenue cycle, or payer operations

• Workflow automation, internal tools, or operational software for expert users

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

• Security, HIPAA, regulated environments, or production systems with high correctness bars

• Early-stage startups, founding engineering roles, staff-level IC work, or tech lead experience

Why join

This is a chance to be one of the senior technical voices at an early company tackling a massive, broken, high-impact market.

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 platform architecture, product judgment, engineering practices, and hiring bar that Backbone will scale from.

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.