Senior Backend Engineer, Infrastructure

Department: Engineering

Location: San Francisco - Hybrid

Compensation: $175K – $250K

Employment Type: FullTime

Ellipsis Health is developing cutting-edge AI/ML products to address healthcare staffing issues and administrative burdens. The platform employs conversational AI and patented vocal biomarker technology to deliver improved healthcare experiences for clients and patients. The team is headquartered in Silicon Valley and is funded and supported by preeminent venture capital groups and healthcare institutions.

Responsibilities:

• Expand and maintain our real-time voice pipeline: design, implement, and

  maintain Python micro-services for conversational AI orchestration—audio

  capture, streaming transcription, prompt/LLM logic, synthesis, and playback.

• Integrate new providers & transports: add plug-ins for emerging ASR, TTS,

  LLM, and memory services; wire up WebRTC, SIP, or phone endpoints; build

  adapters that allow hot-swapping components without downtime. Build API

  endpoints.

• Deliver ultra-low latency (<500 ms round-trip): profile async pipelines (asyncio,

  FastAPI, gRPC), optimize buffering, concurrency, and back-pressure handling.

• Instrument & observe every hop: emit structured traces (OpenTelemetry),

  metrics, and logs for each pipeline stage; define SLOs for first-token latency,

  end-to-end latency, and streaming reliability.

• Harden for production: implement graceful retries, idempotent message

  passing, circuit breakers, and HIPAA-compliant security (encryption in transit,

  per-tenant isolation, secrets rotation).

• Collaborate cross-functionally with ML, product, data engineering, and

  client-SDK teams to deliver features such as voice cloning, multimodal hand-offs,

  and domain-specific memory retrieval.

Qualifications:

• 4+ years building production back-ends in modern Python.

• Proven experience with real-time streaming systems—WebRTC, WebSockets,

  or gRPC streaming—and proficiency with asyncio, FastAPI, or similar async

  frameworks.

• Deep understanding of concurrency, buffering, audio codecs (Opus, PCM), and

  distributed tracing.

• Solid understanding of AWS/GCP/Azure, including container orchestration

  (Kubernetes/EKS/GKE), message queues (Kafka/SQS/Pub/Sub), and IaC

  (Terraform).

• Solid grasp of relational (PostgreSQL) and in-memory (Redis) data stores; able

  to model and persist conversational state.

• Excellent communication skills and a bias for measured, observable, and

  continuously deployable software.

  Bonus Points:

• B.S./M.S. in CS, EE, or related fields.

• Familiarity with voice-agent frameworks,

• Hands-on with telephony (Twilio, Telnyx), SIP, or PSTN integrations.

• Experience integrating multimodal inputs (vision, text chat) into voice agents.

• Familiarity with GPU inference and streaming pipelines.

• Prior work in regulated industries (healthcare, finance) and comfort preparing for

• SOC 2 / HIPAA audits.

Salary and Benefits

We offer competitive salary and benefits, including 401k matching up to a certain

percentage of your salary, health, vision, and dental insurance, and very flexible paid

time off.

The typical salary range for this role is $175,000 to $250,000 USD. The amount

offered will be determined by a variety of factors including but not necessarily limited to

your individual skills, qualifications, and past experience relative to the requirements of

the role.

Background Checks

As a health technology company, we reserve the right to run a background check on

any applicant to which we extend an offer and to re-perform any such check at any time

during the course of employment. Please know that there is no set policy on rejecting

candidates because of certain background check results, and that we look at a

candidate as a whole before making any decisions. We comply with all “ban the box”

laws in applicable jurisdictions.

Assistance

If you have a disability or otherwise require any assistance whatsoever in the

application or recruitment process, please feel free to submit a request to

careers@ellipsishealth.com.