Director, Engineering

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:

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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 talent@garnerhealth.com.