Senior IT Systems Engineer

Garner is on a mission to transform the U.S. healthcare system and were the only proven player doing exactly that. We partner with employers to redesign how healthcare works: applying 550 proprietary clinical metrics across 80 specialties to a dataset of 320M patients to identify the best-performing doctors then using compelling incentives to steer members to the care that helps them get healthier faster.

The result is a rare win win better care and lower costs for both members and just five years our work has helped over 2.5 million people access higher-quality care and saved $1B in healthcare costs. We recently raised our Series E and have doubled five years running. If youve ever wanted your work to solve a problem that touches every person in this country this is the opportunity to do exactly that. Youd be joining a team fundamentally reimagining healthcare in the U.S. and using AI to scale that impact further and faster than anyone else can.

We are looking for an engineer who can walk into messy cross-functional workflows and turn them into clean automated systems that role focuses on identifying high-friction operational processes across the company and replacing them with durable API-driven automation. You will work across IT Security Engineering and Business teams to reduce manual work improve reliability and build systems that scale with the company.

This is not a ticket-driven IT role. You will operate with a high degree of ownership driving initiatives end-to-end from problem discovery through implementation and will be part of the Business Technology - Corporate Engineering team and report to the Director of Business Technology.

This role will be based in our New York City office (in the Financial District). You must be willing to work in the office 3 days per week on Tuesday Wednesday and Thursday.

• Identify and automate high-impact operational workflows across onboarding offboarding access management and service delivery
• Replace manual fragmented processes with scalable API-driven systems
• Build and maintain integrations across HRIS identity providers SaaS platforms and cloud environments
• Develop internal tools and automation using platforms like Retool Okta Workflows and custom scripts or services
• Apply infrastructure-as-code to manage and version system configurations
• Incorporate AI into workflows to improve efficiency in areas like ticket routing knowledge retrieval and decision support
• Design and automate access and security workflows that enforce least-privilege and auditability
• Own and drive cross-functional initiatives end-to-end from problem definition through implementation and rollout

• 47 years of experience in IT platform engineering automation or similar roles
• Strong scripting or programming ability in Python Go PowerShell or similar
• Experience building API-driven automation across multiple systems
• Ability to design and implement workflows that span multiple tools and teams
• Experience with infrastructure-as-code such as Terraform or similar
• A desire to be a part of a high-performing mission-driven team that operates with intense urgency a strong sense of individual accountability and a commitment to authentic feedback

• Hands-on experience with identity and access systems (Okta SSO SCIM RBAC) including implementation and ongoing management
• Proven ability to build and scale internal tools using platforms like Retool or other low-/no-code solutions
• Familiarity with security automation and orchestration (e.g. Tines) with an eye toward reducing manual effort and risk
• Practical experience leveraging AI/LLMs to streamline and enhance operational workflows
• Strong understanding of compliance and security standards (HIPAA SOC 2 HITRUST) and how they shape systems and processes
• Focused on driving meaningful outcomes
• Able to identify root-cause system-level issues and design durable solutions rather than quick fixes
• Comfortable navigating cross-functional environments with competing priorities and constraints
• Operates with urgency while building scalable maintainable solutions
• Defaults to automation and efficiency wherever possible

• Okta Okta Workflows Retool FreshService (ITSM) Google Workspace Slack Atlassian (Confluence and Jira) MDM platforms (Jamf Pro Kandji/Iru Intune) Airtable AWS and GCP Terraform Rippling (HRIS) SOAR (Tines) and AI-enabled operational tooling (Claude Gemini OpenAI)

This is a unique opportunity to join a fast-growing company in a transformative role helping shape the future of healthcare.

Please note: we are unable to sponsor or take over sponsorship of an employment visa at this time.

The target salary range for this position is $189000 - $220000. Individual compensation for this role will depend on various factors including qualifications skills and applicable addition to base compensation this role is eligible to participate in our equity incentive and competitive benefits plans including but not limited to: flexible PTO Medical/Dental/Vision plan options 401(k) Teladoc Health and more.