Senior Backend Software Engineer

Backend at Headway involves high-stakes logic. You’re building a reliable abstraction layer over a fragmented healthcare system. What you could work on: The Modern AI-enabled Clinical System: Help design and build the systems that store and manage clinical data. This isn't just a database; it's a high-integrity system for treatment plans, progress notes, patient history, and AI-powered clinical intelligence - from session transcript-to-note generation to automated summaries that give providers their time back. The Insurance Billing Engine: We apply AI pragmatically to reduce administrative burdens for providers and handle the burden of traditional billing workflows. You’ll scale the systems that handle the unique, often nonsensical rules of every major insurance payer to accurately estimate and file claims hundreds of thousands of times per month. Patient-First Infrastructure: We’re moving toward a patient-centric model. Build the backend services that power personalized care recommendations, health tracking, and longitudinal data views as well as innovative user experiences to help patients find a therapist that meets their needs. Financial Integrity: Work on the ledger systems that ensure 70,000+ providers get paid accurately. This requires building for idempotency and strict consistency in a multi-party marketplace.

Responsibilities

Build a reliable abstraction layer over a fragmented healthcare system; Design and build the systems that store and manage clinical data; Scale the systems that handle insurance payer rules to accurately estimate and file claims; Build backend services for personalized care recommendations, health tracking, and longitudinal data views; Work on the ledger systems that ensure 70,000+ providers get paid accurately

Requirements

Owns Outcomes, Not Tasks: You've been handed ambiguous problems and turned them into shipped software. You know how to define the solution, pull in the right people across teams, and keep things moving when priorities shift.; Sets the Technical Standard: You make technical decisions that optimize for maintainability and scale, not just shipping speed. You proactively improve your team's engineering velocity - whether that's refining tooling, improving automation, or establishing patterns that prevent entire categories of bugs.; Mentor by Default: You pull engineers into design discussions without being asked. Your code reviews teach, not just gatekeep. You make sure knowledge gets shared across the team, not siloed in one person's head.; Ships Fast, Iterates Faster: You can move from problem statement to working solution quickly. You'd rather ship a good v1 this week than a perfect v1 next month.; Quick Study in Complex Domains: Healthcare is a maze of payers, regulations, and exceptions. You don't need prior healthcare experience, but you need to be someone who dives into unfamiliar domains and builds a working mental model fast.; Motivated by Impact: You want your engineering skills applied to problems that matter.; Communicates with Precision: Whether it's a Slack thread, a design doc, or a cross-team meeting, you communicate clearly and concisely.; AI Frontier Tinkerer: You don't just use AI tools - you push their limits. You've experimented with applying LLMs to real workflows, whether that's code generation, operational automation, or developer tooling.; Languages: Python, TypeScript; Storage: Postgres, Redis, Snowflake; Infrastructure: AWS, Temporal; Ops: Datadog, Sentry, PagerDuty; AI Tools: Cursor, Claude, Gemini, Eddy (our in-house cloud agent harness)

Benefits

Medical, dental, vision, HSA/FSA, 401(k), Carrot Fertility reimbursement, 16-week parental leave; Therapy reimbursement; Professional development budget; 13 holidays; Full week off in December; Flexible PTO; Competitive equity package