Senior Backend Engineer

Job title: Senior Backend Engineer

Location: Chicago, IL (In-person strongly preferred; hybrid with monthly fly-in considered for the right person)

Salary: $170,000 – $250,000 + 1.0–2.0% equity

About the company

We're a YC S25 company building AI agents that fight insurance denials for behavioral health clinics. Our product plugs directly into any web-based EMR, scans charts and clinical documentation in real time, identifies anything that could trigger a denial or compliance issue, and emails the right staff member exactly what to fix and how. No rip-and-replace. No IT project. It works on day one.

We went from $0 to $270K contracted ARR in our first month after launch. We're growing 25% week-over-week. We're currently raising a $2.5M round, roughly halfway committed.

The team is 4 people. This hire is #5. You'd be the sole dedicated backend and infrastructure owner.

About the role

This is not a ticket-queue role. There's no senior engineer above you to escalate to. You'll be working directly with the CTO on real architecture problems, owning the backend and infra layer, and making decisions that matter.

The technical interview isn't a LeetCode screen — the CTO will walk you through an actual problem the team is facing and you'll discuss how to solve it together. That tells you something about how this team operates.

We're HIPAA and SOC2 compliant. The data is sensitive. The security bar is real.

What you'll own

• Production backend systems across Linux, containers, cloud, and databases
• Background jobs, queues, and schedulers in production
• HIPAA-grade security across the full stack
• Cross-stack debugging — you can follow a bug from frontend to database without needing a guide
• Architecture decisions as the company scales from early-stage to mature production platform

Who you are

• 3+ years of backend or full-stack engineering experience

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• You've worked at a startup before — a must!
• Strong on the fundamentals: Linux, containers, networking, cloud, databases
• Good security judgment — you think about sensitive data without being reminded to
• You use AI tooling daily (Claude, Cursor, Codex)
• Self-starter — you pick up a problem and start moving
• Mission-aligned — you care about mental health, addiction, or behavioral health, or you're ready to
• Easy to work with, keeps things light even when things are hard
• Based in Chicago or willing to commit to regular in-person time

Bonus points

• Experience at a healthcare AI company (Sully, Heidi, Ambience, Abridge, Written, Ease)
• Experience at a vertical AI company in an adjacent space (Legora, Harvey, Spellbook)
• Strong HIPAA / SOC2 / regulated industry background
• Active GitHub, OSS contributions, or a technical blog
• Personal connection to behavioral health, mental health, or addiction

Compensation & benefits

• $170,000 – $250,000 base salary
• 1.0% – 2.0% equity
• Healthcare and dental fully covered
• Gym membership

Visa sponsorship available. Start date: ASAP.