Director, Engineering

Reposted One Month Ago
Easy Apply
New York, NY, USA
In-Office
435K-450K Annually
Expert/Leader
Big Data • Healthtech • HR Tech • Machine Learning • Software • Telehealth • Big Data Analytics
Garner helps people get better healthcare for less, by steering them to top-performing doctors.
The Role
Lead the Financial Incentives (FIN) engineering function end-to-end (ingestion, eligibility, adjudication, accumulation, payments/treasury). Own correctness, reliability, security, roadmap, hiring and development of managers and senior ICs. Stay hands-on with design, code, and incidents; establish validation standards, event-driven boundaries, AI-native engineering practices, and partner cross-functionally with CTO, Product, Finance, and Operations.
Summary Generated by Built In
What you’ll be part of

Garner is on a mission to transform the U.S. healthcare system — and we’re the only proven player doing exactly that. We partner with employers to redesign how healthcare works: applying 550+ proprietary clinical metrics across 80+ specialties to a dataset of 320M+ patients to identify the best-performing doctors, then using compelling incentives to steer members to the care that helps them get healthier, faster.

The result is a rare “win win” — better care and lower costs for both members and employers. In just five years, our work has helped over 2.5 million people access higher-quality care and saved $1B in healthcare costs. We recently raised our Series E and have doubled five years running. If you've ever wanted your work to solve a problem that touches every person in this country, this is the opportunity to do exactly that. You'd be joining a team fundamentally reimagining healthcare in the U.S. — and using AI to scale that impact further and faster than anyone else can.

About the role:

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.
The ideal candidate has:
  • 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
What you'll get here:

You’ll work on problems that matter, at a company working to change healthcare at scale. You’ll work at the intersection of AI and systemic healthcare reform, where the problems we solve are as interesting and compelling as the mission.

At Garner, you’ll take on real, ambitious problems with real ownership and autonomy, alongside exceptional, principles-based people who genuinely want you to win. It’s demanding by design. You’ll be challenged to stretch beyond what you thought possible and receive consistent coaching to help you grow and do the best work of your career. This isn't the right fit for everyone, and that's intentional. The people here are driven by what's at stake for real people, and that's what gives our intensity its purpose. 

Technologies we use: 
  • 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 $395,000 - $414,000 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.

Fraud and Security Notice: 

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

What the Team is Saying

Pedro
Joanna
Megan
James
Bhavya
Chris

Garner Health Compensation & Benefits Highlights

  • Healthcare Strength The “Garner for Garner” reimbursement is described as meaningfully reducing out-of-pocket medical costs when using Top Providers, with caps up to $4,000 for individuals and $8,000 for families. Company and employer-verified materials present this as a standout element of the package.
  • Leave & Time Off Breadth Flexible/unlimited PTO, 12 weeks paid parental leave, and a fully paid six-week sabbatical after five years indicate broad time-away support. PTO is employer-verified and characterized positively in recent updates.
  • Equity Value & Accessibility Equity is granted to every employee, and stock options are often cited as a valuable component of total rewards. Company materials also reference recurring tender opportunities that can enhance access to equity value.

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The Company
350 Employees
Year Founded: 2019

What We Do

Garner is on a mission to fundamentally change the U.S. healthcare system by building an AI-first marketplace that solves the cost and quality crisis at its core. We analyzed claims records from millions of patients, using data science to objectively measure physician performance and identify the doctors who deliver meaningfully better outcomes at lower cost. We use that data to steer people to those doctors within their existing insurance network. Our products span a member-facing search experience that makes choosing a doctor simple, plus a financial incentive layer — if a member sees a top-performing doctor through Garner, their employer covers all or most of their out-of-pocket costs. Employers keep their existing plan and see lower healthcare costs alongside healthier employees.

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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Employees work remotely.

Typical time on-site: None
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