Staff Software Engineer, Billing & Payments

At Carrum Health, we have built a unique marketplace for specialty care with unparalleled patient experience

Since 2014, we have been rewiring a fundamentally broken healthcare system. By connecting large employers directly with the nation's top-tier providers, our platform replaces a flawed fee-for-service model with one that actually works. If you are passionate about solving complex economic problems, driving systemic change in our healthcare system, and thriving in a people-first culture, we want you on our team. As a high-growth health tech company, we are seeking high-performing, exceptional talent to scale our platform and ensure that anyone in the country facing a specialty procedure has access to the life-changing Carrum benefit.

Our marketplace creates massive value for all stakeholders:

• For Employers (Demand): Predictable, transparent pricing that slashes specialty care costs by up to 45% and eliminates waste

• For Providers (Supply): Ability to gain market share while reducing administrative burden, empowering top-tier doctors to focus completely on delivering optimal care.

• For Members (Users): A life-changing benefit with dedicated concierges, VIP access to the nation's best specialists, and little-to-no out-of-pocket costs.

The salary range for this role is $210,000 - $250,000 depending on geography and level of experience, plus equity and an annual bonus.

As a Staff Software Engineer on our billing and payments platform, you will set the technical direction for the systems that price, bill, and pay for every episode of care that runs through Carrum. That includes:

• Bundled pricing and contracts

• Invoicing and provider payments

• The financial data our Finance and Operations teams rely on

Today, pricing and billing logic is spread across several services. That makes pricing changes slower than they should be, and it makes financial correctness harder to guarantee. Your first big job is to change that. You will centralize pricing into a single pricing service, define clear service boundaries and data models for billing, and lay a foundation that supports new service lines without a rewrite.

You will work primarily in Ruby on Rails in a Service-Oriented Architecture, with React on the front end and PostgreSQL underneath. You will partner with Product, Finance, Operations, and Data. You will also be the engineer others come to when a problem crosses pods or ownership is unclear.

You’re excited about this opportunity because you will...

• Own the technical vision for billing and payments, and turn it into a plan that ships in increments instead of a big-bang rewrite.

• Lead the work to centralize pricing into a single source of truth and decouple billing from the systems it is tangled up with today.

• Own revenue-critical systems end to end. Make them correct, observable, and safe to change, and catch problems before Finance or our clients do.

• Partner with Product and Finance to shape the roadmap, question requirements early, and explain engineering tradeoffs in business terms.

• Lead technical initiatives that span more than one team, without needing positional authority to get them done.

• Write the design docs, ADRs, and diagrams that become the reference for how billing works at Carrum.

• Grow the engineers around you through design reviews, code reviews, and mentoring that improves decisions, not just code.

• Help set how we use AI in a domain where correctness matters. Apply it where it creates leverage, and put guardrails where it does not.

We’re excited about you because…

• You have 8+ years building and running production systems, and you can point to outcomes you drove, not just time served.

• You have led technical initiatives across multiple teams in ambiguous problem spaces, from framing the problem through measurable results.

• You have designed APIs and data models that serve multiple consumers, and you know how to evolve them without breaking the people who depend on them.

• You have production experience in our core technologies: Ruby on Rails (distributed architecture), React, PostgreSQL, Docker, and a major cloud platform (we run on AWS today).

• You treat financial correctness, auditability, monitoring, and safe rollback as core requirements, not afterthoughts.

• You make tradeoffs explicit, separate essential from accidental complexity, and know when "good enough for now" is the right call.

• You can explain complex systems to non-technical stakeholders as clearly as to engineers, and you build trust through follow-through.

• You use AI tools every day to design, build, debug, and document, and you own every line you submit.

• You are entrepreneurial and resourceful. As a member of a startup, we need people who can find creative ways to make a big impact quickly and without much direction.

• Note that we left out all of the other nonsense and standard gibberish you see in every JD, so please tell us you read this far. You will get points for it. Seriously.

Nice to have

• Experience with billing, invoicing, payments, or other financial systems.

• Healthcare payments experience: bundled or value-based pricing, claims, or provider reimbursement.

Why you’ll love working with us...

• We’re a hard-working, humble, and compassionate group motivated to solve the hard problems in healthcare today. You’ll work with talented, experienced co-workers from companies like Booz & Company, Teladoc, Hinge Health, Accolade, Angi, and Optum.

• We champion a collaborative environment where team members can be autonomous, receive support and healthy feedback, and bring their authentic selves to work.

• We carve out time to celebrate our successes and have fun. We’re a remote-first company with employees all over the United States. We offer holistic employee support with flexible working hours, generous time off, paid parental leave, opportunities to connect virtually and in-person, and more.

• We embrace our team’s diversity of thought, experience, and interests and know that doing so makes us stronger as a company. Carrum has an active employee-led Diversity, Equity, Inclusion, and Justice (DEIJ) committee alongside several employee resource groups (ERGs) that support parents, women, and various underrepresented groups.

• You’ll feel proud that the work you do each day directly impacts people’s lives in big and meaningful ways.

• Carrum is remote-first, but we believe the best work often happens in person. This role may include occasional travel for team offsites, client events, or company gatherings.

Other benefits:

• Stock option plan and performance bonus for eligible employees

• Flexible schedules and remote work

• Chicago and San Francisco offices available as an option

• Flexible PTO, within reason

• Summer Fridays (sign off @ 1pm local time)

• 15+ paid holidays, including Juneteenth, World Mental Health Day, and Carrum Health Day

• Annual holiday shutdown in December

• Paid parental leave

• Health, vision, and dental insurance

• Employee Assistance Programs (EAP)

• 401K retirement plan

About Carrum

Carrum Health’s mission is to change how we pay for and deliver specialty care. We offer self-insured employers and plan sponsors a value-based specialty care platform that connects their members with a rigorously vetted network of specialty care providers. Carrum’s transparent, all-inclusive bundled pricing, award-winning technology, and dedicated care navigation team help lower costs for both members and employers while delivering a superior member experience. Carrum is independently validated to reduce unnecessary procedures by as much as 30%, lower readmissions by 80%, and save employers up to 45% per episode of surgical care. Learn more at carrumhealth.com.

Since launching in 2014, we’ve partnered with top-quality providers across the nation including Cleveland Clinic, Johns Hopkins, Mayo Clinic, Stanford Health Care, and a growing network of 1,400+ COEs. We serve hundreds of self-insured employers including Fortune 50 companies, such as United Airlines, US Foods, and Prudential, and public sector clients such as the States of Maine, Nevada, Tennessee, and Self-Insured Schools of California.

The impact of our platform has been validated by a landmark RAND Corporation study, honored with prestigious awards from institutions like Harvard Business School & Harvard Medical School, and featured as a Harvard Business School case study.

As a recognized digital health leader, Carrum is frequently covered by national media, including Bloomberg, Fast Company, Fierce Healthcare, Fortune, Los Angeles Times, Reuters, TechCrunch, and U.S News & World Report. Backed by $96M from top-tier investors including OMERS, Tiger Global Management, Revelation Partners and Wildcat Ventures, we’re only scratching the surface of our opportunity. Come join us.

Carrum Health is an equal opportunity employer and encourages all applicants from every background and life experience.

A Note on Recruitment Safety: To protect yourself against recruitment fraud, please note that Carrum Health will only communicate via an @carrumhealth.com email address. We do not conduct interviews via text or messaging apps, nor do we ever request financial information or fees during the hiring process. All authentic job openings are posted at carrumhealth.com/careers. If you are unsure about the legitimacy of a communication, please verify it via talent@carrumhealth.com.