Founding Engineer

About the Role We're a small, fast-moving seed-stage healthtech startup building AI-powered software that modernizes billing and operations for Emergency Medical Services (EMS) agencies. Our platform automates denial resolution, appeal generation, payer outreach, and compliance workflows — helping paramedics get paid and protecting 911 services across the country. We're looking for a Founding Engineer to join as one of the earliest technical hires. This role blends hands-on, end-to-end engineering with direct customer engagement — you'll talk to billers, fire chiefs, and ops leaders as often as you write code. If you thrive in a high-ownership environment and want your work to have immediate, measurable impact, this role is for you. What You'll Do Own architecture, development, deployment, and on-call responsibilities across the full stack. Build and ship customer-facing features informed by direct conversations with EMS billers and agency operators. Design and implement automation that eliminates manual work and drives meaningful revenue recovery for agencies. Make thoughtful product and design tradeoffs with a strong UX sensibility. Iterate rapidly: deploy, gather customer feedback, and continuously improve. Collaborate closely with the founding team in a hybrid in-person setting (San Francisco, 2–3 days per week). What We're Looking For Required: 1–3 years of experience building full-stack products end-to-end, with demonstrated ownership of complete features. Proficiency in React and a track record of delivering polished, customer-facing UIs with strong UX sensibility. Experience translating customer needs into technical deliverables and building features that interact with external APIs. Hands-on experience with LLMs and Retrieval-Augmented Generation (RAG) architectures — this is a dealbreaker requirement. Strong CS fundamentals, high attention to detail, fast learner, and clear communicator. Nice to Have: Backend and infrastructure experience with Go, PostgreSQL, and Google Cloud. Background in EMS, 911 dispatch, healthcare, or insurance billing. NREMT certification (a significant plus). Prior experience as a founder or founding engineer at an early-stage startup. Visa: OPT and STEM OPT candidates are welcome; the team will work with you on next steps. Formal visa sponsorship is not available at this time. Location This is a hybrid role based in San Francisco, CA. You'll be expected in the office 2–3 days per week to work closely with the founding team. Remote candidates are not being considered for this position. Compensation & Benefits Salary: $120,000 – $190,000 USD annually, depending on experience. Early-stage equity as a founding team member. High-impact, high-ownership role at the ground floor of a mission-driven healthtech company.