Founding Backend Engineer – Clinical AI Infrastructure

Backbone; San Francisco (CA); On-site; USD 180,000 - 280,000; Full time

Job summary

Backbone is building the clinical AI layer for healthcare payments. Founding Engineer, Backend & Infrastructure will own the systems that power Backbone’s clinical and financial workflows, including chart and claims data, authorization, denial handling, and payer/provider integrations.

You’ll develop orchestration for long-running workflows across EHRs and payer portals, and advance reliability, observability, and production-grade ML capabilities.

Qualifications

• 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.

Responsibilities

• Build and scale distributed backend systems powering Backbone’s clinical and financial workflows.
• Own backend services across chart data, claims data, authorization workflows, denial workflows, and payer/provider integrations.
• Develop orchestration infrastructure for long-running, failure-prone workflows across EHRs 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 and build observability, retry, audit, and human-in-the-loop infrastructure.
• Collaborate with product and research engineers to productionize new clinical intelligence capabilities and set engineering patterns.

Skills

Backend

Data

ML in production

Distributed systems

Microservices

Workflow engines

Job description

Backbone is building the clinical AI layer for healthcare payments. Founding Engineer, Backend & Infrastructure will own the systems that power Backbone’s clinical and financial workflows, including chart and claims data, authorization, denial handling, and payer/provider integrations.

You’ll develop orchestration for long-running workflows across EHRs and payer portals, and advance reliability, observability, and production-grade ML capabilities.