Senior Backend Engineer, Infrastructure

Job-ID: 67e82acf-4394-471c-bbc1-fd825df4fab4Location: San Francisco, California, United StatesSalary: USD 175000 - 250000 yearEmployment type: FULL TIMEPosted: 2026-05-01Ellipsis Health is developing cutting-edge AI/ML products to address healthcare staffing issues and administrative burdens. The platform employs conversational AI and patented vocal biomarker technology to deliver improved healthcare experiences for clients and patients. The team is headquartered in Silicon Valley and is funded and supported by preeminent venture capital groups and healthcare institutions. Responsibilities: Expand and maintain our real-time voice pipeline: design, implement, andmaintain Python micro-services for conversational AI orchestration—audiocapture, streaming transcription, prompt/LLM logic, synthesis, and playback. Integrate new providers & transports: add plug-ins for emerging ASR, TTS,LLM, and memory services; wire up WebRTC, SIP, or phone endpoints; buildadapters that allow hot-swapping components without downtime. Build APIendpoints. Deliver ultra-low latency (<500 ms round-trip): profile async pipelines (asyncio,FastAPI, gRPC), optimize buffering, concurrency, and back-pressure handling. Instrument & observe every hop: emit structured traces (OpenTelemetry),metrics, and logs for each pipeline stage; define SLOs for first-token latency,end-to-end latency, and streaming reliability. Harden for production: implement graceful retries, idempotent messagepassing, circuit breakers, and HIPAA-compliant security (encryption in transit,per-tenant isolation, secrets rotation). Collaborate cross-functionally with ML, product, data engineering, andclient-SDK teams to deliver features such as voice cloning, multimodal hand-offs,and domain-specific memory retrieval.Qualifications: 4+ years building production back-ends in modern Python. Proven experience with real-time streaming systems—WebRTC, WebSockets,or gRPC streaming—and proficiency with asyncio, FastAPI, or similar asyncframeworks. Deep understanding of concurrency, buffering, audio codecs (Opus, PCM), anddistributed tracing. Solid understanding of AWS/GCP/Azure, including container orchestration(Kubernetes/EKS/GKE), message queues (Kafka/SQS/Pub/Sub), and IaC(Terraform). Solid grasp of relational (PostgreSQL) and in-memory (Redis) data stores; ableto model and persist conversational state. Excellent communication skills and a bias for measured, observable, andcontinuously deployable software.Bonus Points: B.S./M.S. in CS, EE, or related fields. Familiarity with voice-agent frameworks, Hands-on with telephony (Twilio, Telnyx), SIP, or PSTN integrations. Experience integrating multimodal inputs (vision, text chat) into voice agents. Familiarity with GPU inference and streaming pipelines. Prior work in regulated industries (healthcare, finance) and comfort preparing forSOC 2 / HIPAA audits.Salary and BenefitsWe offer competitive salary and benefits, including 401k matching up to a certainpercentage of your salary, health, vision, and dental insurance, and very flexible paidtime off.The typical salary range for this role is $175,000 to $250,000 USD. The amountoffered will be determined by a variety of factors including but not necessarily limited toyour individual skills, qualifications, and past experience relative to the requirements ofthe role.Background ChecksAs a health technology company, we reserve the right to run a background check onany applicant to which we extend an offer and to re-perform any such check at any timeduring the course of employment. Please know that there is no set policy on rejectingcandidates because of certain background check results, and that we look at acandidate as a whole before making any decisions. We comply with all “ban the box”laws in applicable jurisdictions.AssistanceIf you have a disability or otherwise require any assistance whatsoever in theapplication or recruitment process, please feel free to submit a request View email address on click.appcast.io.