Senior Backend Engineer

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 & Values We 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. Responsibilities As a Senior Backend Engineer, you will engineer production agentic systems that directly serve hundreds of thousands of users at scale. Think forward-deployed engineering: you take powerful platform capabilities, design multi-step workflows that orchestrate voice, SMS, video, and web interactions, and ship them to production where real outcomes are measured. The problems are genuinely hard. You're building systems that navigate complex conversations in multiple mediums, handle sensitive nuances and edge cases in multiple languages, coordinate multi-outcome workflows across departments, and adapt dynamically based on user responses. You will innovate on how agentic technologies can be pushed to their maximum potential, not follow a playbook. Roughly 60-70% of your time is deployment-focused. The remainder is platform contribution: building reusable workflow primitives, improving shared infrastructure based on patterns you see across customers, and shaping how we architect agentic systems at scale. Your field experience makes you one of the most valuable voices in platform decisions. Engineer Agentic Deployments: Design, build, and ship multi-step, multi-modal agentic workflows (voice, SMS, video, chat, web) tailored to specific customer use cases. Own these systems end-to-end from requirements through production monitoring. Solve Hard Problems Creatively: Each deployment surfaces novel challenges: complex scheduling logic, real-time EHR data flows, multi-outcome conversations, adaptive patient journeys. You are expected to think independently and build solutions that go beyond existing patterns. Translate Requirements into Technical Designs: Partner with Customer Success and stakeholders to understand operational needs, then architect agentic workflows that address them. Push back when requirements don't make sense. Propose better approaches when you see them. Ship to Production with High Standards: Deploy and operate customer-facing systems with strict reliability, compliance, and quality requirements. Instrument thoroughly, monitor outcomes, and iterate based on real-world performance. Contribute to the Platform: Identify reusable patterns across deployments and contribute them back as platform capabilities. Improve shared tooling, workflow primitives, and infrastructure based on what you learn in the field. Cross-Functional Collaboration: Work with product, data, engineering, and clinical teams to align deployment work with broader platform direction and company goals. Minimum Qualifications 5+ years of hands-on experience building and operating production software systems. Recent experience with AI-powered services, automation, or workflow systems is a strong plus. Computer Science or Engineering degree, or equivalent practical experience. Strong software engineering fundamentals: you write clean, testable, well-structured code and care about the systems you build. Python proficiency (our primary backend language). Proficiency with AI-assisted development tools (e.g., Cursor, Claude Code, GitHub Copilot). Experience with real-time integrations (APIs, webhooks, bidirectional data sync) in production. Experience working across the stack when needed. You're primarily backend-focused but not afraid to touch whatever layer the problem requires. Experience with cloud infrastructure (AWS, GCP, or Azure) and production deployments. Comfort with ambiguity. You can take a loosely defined problem, structure it, and drive it to a shipped solution without heavy hand-holding. Strong communication skills. You will regularly interface with non-technical stakeholders and need to explain technical tradeoffs clearly. Preferred Qualifications Experience building agentic workflows, including orchestration across tools and services, multi-step automation, or human-in-the-loop patterns. Experience integrating LLM APIs and working with prompt engineering and evaluation. Track record of working directly with customers or end users and translating their needs into technical solutions. 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 Benefits We 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 Transparency The 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.