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Harness Engineer

Substrate· Engineering
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Hybrid (San Francisco, CA)$140k - $200k + equityFull-timePosted 6mo ago

About the role

Role focused on building and deploying AI-native systems and agents for healthcare RCM at Substrate, improving AI/ML models and production infrastructure to process tens of millions of claims annually.

Responsibilities

  • Build and extend our suite of agents - Design agents and the systems around them to do a variety of tasks for healthcare practices, including monitoring claims, reviewing payer policies, determine medical necessity, iterate through messy provider data, reconcile payments, and more.
  • Deploy agents and the systems around them - Partner with clients and prospects on frontier use cases, getting agents to work safely in extremely sensitive environments.
  • Develop high quality measurement infrastructure: improve how we measure and track agent and model behavior, increase precision, and build systems to help optimize speed, and cost on production traffic touching tens of millions of claims each year.
  • Adapt with the nature of work: explore how to be more effective, efficient and leveraged as the toolscape evolves rapidly around us.

Qualifications

  • 3+ years of experience
  • Deep experience with modern LLM architectures, fine-tuning approaches, and utilizing evals at scale
  • Healthcare domain knowledge or interest in automating healthcare via AI
  • Proficient software engineering skills and experience integrating coding agents into workflow
  • Willingness to work in person in San Francisco, 3 days a week

Skills

Required:LLM architecturesFine-tuningAI product development
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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