Garner’s mission is to transform the healthcare economy, delivering high-quality and affordable care for all.
We are fundamentally reimagining how healthcare works in the U.S. by partnering with employers to redesign healthcare benefits using clear incentives and powerful, data-driven insights. Our approach guides employees to higher-quality, lower-cost care, creating a system that works better for everyone. Patients achieve better health outcomes, employers spend healthcare dollars more effectively, and physicians are rewarded for delivering exceptional care rather than performing more procedures.
Garner is one of the fastest-growing healthcare technology companies in the country. Our products are trusted by the most sophisticated employers and providers in the industry, and we are building a team of talented, mission-driven individuals who are motivated to make a meaningful impact on healthcare at scale.
Financial Incentives (FIN) is where Garner's promise becomes real for a member: the moment they are paid back for choosing better care. Behind that simple experience sits one of the hardest problems in the company. FIN ingests claims and eligibility feeds from third-party administrators, adjudicates them against benefit rules, accumulates member benefit, and moves real funds through payments and treasury. It does this under heavy and growing load, carrying PHI and PII, at the point where high-volume data from outside partners first enters Garner. When FIN is right, members are paid accurately and on time. When it is wrong, the failure is financial and visible.
We are hiring a Director to lead FIN Engineering, accountable for the full function (ingestion, eligibility, adjudication, accumulation, and payments/treasury): its correctness, reliability, security, and the pace at which it improves. You will lead a large, multi-team function, own its multi-year roadmap, and contribute to company-wide planning. The role is hands-on-keys: you will stay close to the code, the designs, and the incidents to hold a real technical opinion, and set an engineering quality bar the rest of the department measures itself against.
You will report to the CTO and lead a group of Engineering Managers and senior individual contributors across FIN's value streams.
Where you will work:This role will be based in our New York City office (in the Financial District). You must be willing to work in the office 3 days per week on Tuesday, Wednesday and Thursday.
What you will do:- Own the outcomes, ingestion through payment. Define what "correct" means for adjudication and money movement, and be accountable for adjudication accuracy, payment timeliness, ledger reconciliation, ingestion SLAs, and the roadmap that moves them.
- Set the bar and the pace. Establish the validation standards and definition of "done" the function ships against and hold the line under delivery pressure, running a performance culture on evidence: highest-value work first, manual toil automated away, engineers accountable for outcomes.
- Stay close to the work. Join the hard design reviews, read the code, dig into incidents, and hold defensible technical positions on adjudication logic, event contracts, data modeling, and money movement.
- Make agent-first the default. Make AI-native engineering how FIN works, not a side experiment: build the harnesses, validation frameworks, and Claude Skills that let squads ship faster and safer, and mature the org from assisted toward autonomous with real guardrails.
- Own the technical direction. Guide the backend toward event-contract boundaries that let teams ship independently and scale to tens of millions of claims, with the fault tolerance a pipeline that cannot drop or double-pay a claim demands, and own the security and data-integrity posture at the edge where partner data enters and funds leave: validate, quarantine, and reconcile rather than assume the inputs are clean.
- Build and grow the team. Hire, level, and develop Engineering Managers and senior ICs, own interviewer calibration, and design the org's structure and decision rights so ownership is clear.
- Translate across the business. Partner with the CTO, Product, Finance, Operations, and payment partners to turn business needs into technical plans and communicate risk and tradeoffs in terms leaders can act on.
- 10+ years building and operating high-scale, high-reliability backend systems, ideally ones that process large data volumes and/or move money.
- 5+ years leading engineering teams, including managing managers, in a high-accountability, high-urgency environment.
- Technical credibility at scale: you can reason through a design doc, a schema, or an incident timeline and write the validation criteria that catch failure.
- An opinionated point of view on agent-first / AI-native engineering: not just that teams should use AI, but how to make it the default operating model and mature it safely from assisted toward autonomous.
- Experience with the demands of sensitive data (regulated PHI/PII/financial data, unvalidated third-party inputs, encryption, access, audit) and an instinct for reconciliation-first design.
- Fluency in distributed systems and modern cloud: event-driven architecture, idempotency, fault tolerance, backpressure, and data consistency under load, plus AWS and API design.
- An ownership mindset: you move problems to resolution without being asked and optimize relentlessly for member and business impact.
- A desire to be a part of a high-performing, mission-driven team that operates with intense urgency, a strong sense of individual accountability, and a commitment to authentic feedback
- Python, TypeScript, React, NodeJS, Kubernetes, Istio, Postgres, ElasticSearch, NATS, AWS, Terraform
This is a unique opportunity to join a fast-growing company in a transformative role, helping shape the future of healthcare.
Compensation Transparency:The target salary range for this position is $435,000 - $450,000 inclusive of bonus. Individual compensation for this role will depend on various factors, including qualifications, skills, and applicable laws. In addition to base compensation, this role is eligible to participate in our equity incentive and competitive benefits plans, including but not limited to: flexible PTO, Medical/Dental/Vision plan options, 401(k), Teladoc Health and more.
Please be aware of recent job scam attempts. Our recruiters use getgarner.com and garnerhealth.com email domains exclusively. If you have been contacted by someone claiming to be a Garner recruiter or a hiring manager from a different domain about a potential job, please report it to law enforcement here and to [email protected].
Equal Employment Opportunity:Garner Health is proud to be an Equal Employment Opportunity employer and values diversity in the workplace. We do not discriminate based upon race, religion, color, national origin, sex (including pregnancy, childbirth, reproductive health decisions, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, genetic information, political views or activity, or other applicable legally protected characteristics.Garner Health is committed to providing accommodations for qualified individuals with disabilities in our recruiting process. If you need assistance or an accommodation due to a disability, you may contact us at [email protected].
Skills Required
- 10+ years building and operating high-scale, high-reliability backend systems
- 5+ years leading engineering teams, including managing managers
- Technical credibility to reason through design docs, schemas, and incident timelines and write validation criteria
- Opinionated experience with agent-first / AI-native engineering and how to mature it safely
- Experience with sensitive data (PHI/PII/financial), encryption, access, audit, and reconciliation-first design
- Fluency in distributed systems and modern cloud: event-driven architecture, idempotency, fault tolerance, backpressure, data consistency, plus AWS and API design
- Hands-on involvement with code, design reviews, and incident response
- Willingness to work in New York City office three days per week (Tue/Wed/Thu)
- Experience building/operating systems that process large data volumes and/or move money/payments/treasury
Garner Health Compensation & Benefits Highlights
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Healthcare Strength — Healthcare support includes the “Garner for Garner” reimbursement that can drive near‑zero out‑of‑pocket costs when using Top Providers, with caps cited as up to $4,000 individual and $8,000 family (some listings show $3,500/$7,000). Core medical, dental, and vision coverage is included.
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Parental & Family Support — Paid parental leave of 12 weeks for all paths to parenthood is explicitly provided. Family medical leave support is also described.
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Leave & Time Off Breadth — Flexible PTO for salaried employees is offered, alongside a fully paid six‑week sabbatical after five years. These policies emphasize time away options beyond standard vacation.
Garner Health Insights
What We Do
Garner Health is a health tech startup that is transforming the healthcare economy by enabling patients to receive high-quality and affordable care. Garner Health has two core offerings: Garner, a benefit program that uses a new approach to data science and incentive accounts to help employees find the best doctors in their communities, and Garner DataPro, a provider recommendation platform that serves referrals based on the most accurate provider performance and directory data in the industry. Garner Health’s offerings utilize over 75% of the medical claims data in the United States to objectively examine patient outcomes based on more than 500 specialty-specific quality and efficiency measures. By analyzing millions of healthcare journeys across 82 distinct medical specialties, Garner Health sets a new industry standard in delivering reliable, actionable referrals and navigating patients to the highest-quality providers. Garner Health is a remote-first company based in NYC.
Why Work With Us
Our values connect us in caring deeply about doing something different and hard — transforming the healthcare economy. They create an actionable set of norms for how we operate, including how we make decisions and support one another. Learn about our values here: https://www.getgarner.com/about.
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