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Agent Engineer (Senior)

Substrate· Engineering
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Hybrid (San Francisco, CA)$125k - $200k + equityFull-timePosted 8mo ago

About the role

Senior AI Agent engineer role at Substrate to build an autonomous agent platform for healthcare RCM, focusing on AI systems that handle complex contracts, EDI guides, and sensitive healthcare workflows with memory of interactions.

Responsibilities

  • Build and extend the Claim Status Agent - design intelligent sub-agent architectures for multi-route claim lookups (EDI 276/277, payer portals, direct APIs, multiple clearinghouses) and implement real-time recovery strategies
  • Develop self-enriching context systems - memory infrastructure to remember effective parameter combinations and optimal routing across thousands of payers
  • Fine-tune models and build evaluation frameworks - improve precision, speed, and cost on production traffic processing (~6m claims/year) and design evaluations to catch regressions
  • Expand the agent's capability surface - integrate new modalities (voice, direct payer connections) and process varied context across EDI guides, payer contracts, PDFs, images, and API outputs

Qualifications

  • 3+ years experience
  • Independent track record of building and shipping ML/AI products that solve real business problems
  • Deep experience with modern LLM architectures, fine-tuning, and large-scale evals
  • Healthcare domain knowledge or strong interest in applying AI to automate healthcare tedium
  • Experience as startup engineer in small teams or prior entrepreneurial experience
  • Proficiency as a software engineer who uses coding agents in workflow
  • Willingness to work in person in San Francisco, CA, US

Skills

Required:AI/ML product developmentLLM architectures and fine-tuningMemory/context systems
Nice to have:Healthcare domain knowledge

Benefits

  • Meaningful salary and equity available
Last updated Aug 26, 2026. Interested? Apply on the company site.
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About Substrate

Artificial Intelligence for your medical billing team

Substrate's AI agents automate the click-work & data entry in revenue cycle management. Our agents perform repetitive and time-consuming tasks on behalf of medical billers, significantly increasing efficiency and reducing errors.

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