Arbiter is the AI-powered care orchestration system that unites healthcare. We are launching our best-in-class, patient-facing Agentic platform to optimize patient outcomes through a unique multimodal approach. We optimize complex healthcare workflows that interface with patients using the latest Agentic AI approaches, and we combine it with a sophisticated platform to serve this Agentic layer at scale. We are looking for expert engineers and leads to join our team and help us push the frontier of what's possible with Agentic workflows + Healthcare.Backed by one of the largest seed rounds in health tech history and operators who bring the expertise and distribution to scale nationally, we're building the connected infrastructure healthcare should have had all along.Our Engineering Culture & ValuesWe are a high-performing group of engineers dedicated to delivering innovative, high-quality solutions to our clients and business partners. We believe in:Engineering Excellence: Taking immense pride in our technical craft and the products we build, treating both with utmost respect and care.Impact-Driven Development: Firmly committed to engineering high-quality, fault-tolerant, and highly scalable systems that evolve seamlessly with business needs, minimizing disruption.Collaboration Over Ego: Valuing exceptional work and groundbreaking ideas above all else. We seek talented individuals who are accustomed to working in a fast-paced environment and are driven to ship often to achieve significant impact.Continuous Growth: Fostering an environment of continuous learning, mentorship, and professional development, where you can deepen your expertise and grow your career.ResponsibilitiesAs a Senior Backend Engineer, you will design, build, and operate the platform systems that power Arbiter's connections to the outside world and ensure reliable, performant data exchange across a complex ecosystem. You will own critical parts of our backend infrastructure, from API design and service orchestration to data pipelines and third-party system connectivity, working closely with product, engineering, and customer teams to ship production-grade systems with real customer dependency.Platform Architecture & Backend Systems: Design, develop, and operate backend services that power Arbiter's core platform, with an emphasis on reliability, modularity, and clean system boundaries.External System Connectivity: Build and maintain robust connections to third-party systems (e.g. cloud APIs, AI services, data exchange services, EHRs, telephony platforms). Own the abstractions that make these integrations reusable and adaptable across customers with minimal rework.API Design & Data Exchange: Design and operate high-scale APIs (REST, gRPC, webhooks) and manage complex data flows including real-time streaming, batch processing, file-based exchange (e.g. SFTP, HL7, EDI), and event-driven pipelines.Performance & Reliability: Ensure high throughput, low latency, and fault tolerance across backend services through strong system design, monitoring, alerting, and operational best practices. Handle vendor failures, retries, idempotency, and graceful degradation.Data Engineering & Pipeline Ownership: Build and maintain ETL/ELT pipelines, manage schema evolution, and ensure data quality and integrity across systems with varying formats, standards, and reliability.Infrastructure & Deployment Excellence: Implement and uphold best practices for CI/CD, testing, observability, and deployment of backend systems in production cloud environments.Cross-Functional Execution: Partner closely with AI engineers, product managers, implementation teams, and customer stakeholders to translate ambiguous, high-impact problems into scalable technical solutions.Technical Leadership & Mentorship: Mentor engineers, contribute to internal documentation and standards, influence technical direction, and raise the overall engineering bar.Ownership & On-Call: Take end-to-end ownership of critical systems, including participating in on-call rotations and leading incident resolution when production issues arise.Minimum Qualifications5+ years of hands-on experience building and operating production backend systems in high-availability environments.Computer Science or Engineering degree, or equivalent practical experience.Experience building and maintaining large-scale Python codebases with strong opinions on structure, quality, and tradeoffs.Deep understanding of API design patterns, versioning, backward compatibility, and managing breaking changes across consumers.Experience building reusable abstraction layers or connector frameworks that allow a single integration pattern to serve multiple customers or vendors.Proven experience designing systems that connect to third-party services, including handling authentication, rate limiting, retry logic, and failure modes gracefully.Strong understanding of concurrency, scalability, reliability, and distributed systems patterns.Hands-on experience with data pipeline architectures: batch and streaming, schema management, and data quality enforcement.Experience with cloud infrastructure (AWS, GCP, or Azure) and production deployments.Strong communication skills and ability to work effectively across functions.Proficiency with AI-assisted development tools (e.g., Cursor, Claude Code, GitHub Copilot).Track record of delivering complex systems end-to-end with minimal oversight.Preferred QualificationsExperience with healthcare data exchange standards (HL7, FHIR, EDI) or similarly complex domain-specific protocols in other industries (fintech, telecom, logistics) is a plus.Familiarity with database performance tuning, query optimization, and managing large-scale relational databases (PostgreSQL, CloudSQL).Startup or early-stage experience operating in fast-moving, high-ambiguity environments.This role can be remote or on-site, based in our New York City or Boca Raton offices, in a fast-paced, collaborative environment where great ideas move quickly from whiteboard to production.Job BenefitsWe offer a comprehensive and competitive benefits package designed to support your well-being and professional growth:Highly Competitive Salary & Equity Package: Designed to rival top FAANG compensation, including meaningful equity.Generous Paid Time Off (PTO): To ensure a healthy work-life balance.Comprehensive Health, Vision, and Dental Insurance: Robust coverage for you and your family.Life and Disability Insurance: Providing financial security.Simple IRA Matching: To support your long-term financial goals.Professional Development Budget: Support for conferences, courses, and certifications to fuel your continuous learning.Wellness Programs: Initiatives to support your physical and mental health.Pay TransparencyThe annual base salary range for this position is $148,500-$190,000. Actual compensation offered to the successful candidate may vary from the posted hiring range based on work experience, skill level, and other factors.Please mention the word **LAUDABLE** and tag RNTEuMTU5Ljc2LjI5 when applying to show you read the job post completely (#RNTEuMTU5Ljc2LjI5). This is a beta feature to avoid spam applicants. Companies can search these words to find applicants that read this and see they're human.