Founding Engineer, Forward Deployed

Backbone; San Francisco (CA); On-site; USD 180,000 - 240,000; Full time

Job summary

Backbone is hiring a founding engineer in San Francisco to work closely with providers and payers, turning workflow observations into practical product changes and shipping reliable software. You’ll own core workflows, contribute across the stack, and communicate clearly with customers and teammates.

You’ll collaborate with the CEO and engineering team from pilot through deployment, address live issues, and travel to customer sites as needed to ensure successful deployments.

Qualifications

• 1-4 years of software engineering experience.
• Strong full-stack execution with a backend bias and evidence of shipped software.
• Excellent communication and product judgment, able to turn ambiguity into concrete implementation.
• High ownership and urgency in messy, real-world environments.

Responsibilities

• Understand provider/payer workflows and translate observations into product changes that ship quickly and safely.
• Debug live customer issues across charts, claims, payer portals, EHR/PM systems, policy rules and queues.
• Identify workflow gaps that may not be bugs but affect customer experience.
• Collaborate with the CEO and engineering from pilot through customer close and post-close expansion.
• Travel to customers when it materially improves product understanding and deployment quality.

Skills

Full-stack development

Backend development

Customer communication

Product judgment

Ownership

Job description

Founding Engineer, Forward Deployed

About Backbone

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.

What you’ll do

As one of the core members of our engineering team, you’ll sit close to providers and payers, understand how their workflows actually run, and turn what you learn into product implementation. You’ll close the loop from customer pain to shipped software: observe the workflow, understand the clinical and operational context, identify what needs to change, build it, deploy it, and make sure it works.

You’ll spend meaningful time with customers, but the center of gravity is engineering. We’re looking for someone who can communicate clearly, think like a product owner, and ship like a strong engineer.

You will:

• Sit with providers, payers, and operations teams to understand how authorizations, claims, denials, appeals, and payment workflows actually happen.

• Translate messy workflow observations into product changes that ship quickly and safely

• Debug live customer issues across charts, claims, payer portals, EHR/PM systems, policy rules, and operational queues

• Identify workflow gaps that may not look like "bugs" but still break the customer experience

• Work directly with the CEO and engineering team from pilot through customer close and post-close expansion.

• Travel to customers when it materially improves product understanding and deployment quality

What we’re looking for

• 1-4 years of software engineering experience

• Strong full-stack execution with a backend bias, with clear evidence that you have shipped real software in the past

• Strong communication and product judgment: you can talk to a customer, ask clear questions, and turn ambiguity into implementation across the engineering-product-design cycle

• High ownership and urgency. You find the shortest path from customer pain to working software within messy, real-world environments

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

Why join

This is a chance to join early and help define both the product and the engineering culture.

You’ll work on hard, practical problems: turning fragmented healthcare workflows into software that actually helps people do their jobs faster and better. Your work will touch product decisions, system architecture, user experience, and the core automation engine behind Backbone.

We offer competitive compensation, meaningful ownership, and the opportunity to build foundational technology in a massive, broken, high-impact industry.