Founding Engineer — Overdrive Health (YC W26)

New York City (In-Person) · Full-Time

About Overdrive Health

Overdrive Health is an AI-native medical billing company automating the entire revenue cycle management lifecycle, starting with the $2B ambulance billing industry. We acquire traditional billing companies and deploy AI to automate their workflows — insurance phone calls, documentation checks, benefit verification, claim submission, denial management, and more. We're already serving 20+ ambulance providers and processing over $50M in claims per year.

The Role

You'd be the first engineering hire, working directly with the founder to build and expand the AI systems that power our billing operations. This is not a research role — our agents are already in production handling real claims and real money. You'll be shipping code that has a direct, measurable impact on revenue from day one.

The work spans building and improving AI agents (LLM-powered systems that interact with insurance companies, process documents, and manage claims workflows), designing the backend infrastructure that ties it all together, and building internal tools when needed to support our billing operations team. You should be the kind of engineer who's more excited about solving a gnarly integration problem with a payer API than picking a frontend framework.

What You'll Do

• Build and iterate on AI agents that automate core billing workflows (phone calls, claim follow-ups, denial appeals, benefit verification)
• Design and maintain backend systems, data pipelines, and integrations with healthcare/insurance infrastructure
• Make foundational architectural decisions that will scale as we expand into new medical verticals
• Build internal tooling to support our operations team
• Work directly with our billing team to understand where automation creates the most leverage and ship solutions quickly

What We're Looking For

• Strong backend engineering fundamentals — you're comfortable designing systems, writing reliable production code, and debugging hairy problems across the stack
• Experience building with LLMs, AI agents, or similar systems — you've put something into production, not just prototyped in a notebook
• Bias toward shipping — we're a small team operating in a fast feedback loop; you care more about solving the problem than perfecting the abstraction
• Comfort with ambiguity — you'll often be deciding what to build, not just how to build it
• Python proficiency (our stack is Python-heavy)

Nice to Have

• Experience in healthcare, billing, insurance, or other heavily regulated/operationally complex industries
• Background working with telephony systems, document processing, or workflow automation
• Previous early-stage startup experience

Compensation

Competitive salary + meaningful equity. You'd be the first engineer at a YC-backed company with real revenue and a clear path to scale.