At Commure, we're building the AI Operating System for healthcare, the foundation that defines how care is delivered, documented, and financed. Our platform spans the full care journey: Ambient AI and Dictation eliminating documentation burden at the point of care, intelligent Agents automating patient and revenue workflows, and autonomous RCM processing billions in claims, all on a single AI-native platform integrated with 60+ EHRs.

Healthcare carries a $1 trillion administrative burden and we're at the center of transforming it. Today, 500,000+ clinicians across 500+ healthcare organizations nationwide trust Commure to handle $25B+ in annual claims and support over 200 million patient interactions. Our latest $70M raise at a $7B valuation reflects the confidence the market has placed in this mission. We've also been named to the Fortune Future 50 list and the 2026 AI Breakthrough Awards for “Overall NLP Company of the Year.”

Our team works directly alongside clinicians, not through layers of process, which means the gap between what you build and its impact on patient care is immediate. We move fast, deploy daily, and take full ownership from early thinking to production. If you're energized by hard problems, high stakes, and a team that holds itself to a high bar, you'll find your people here.

The future of healthcare is being built right now. Come deliver this transformation.

About the Role

We're hiring a Staff Software Engineer to own the accounts and ledgering spine of our RCM platform. This is the path from "insurance paid us" to "the books balance, the patient knows what they owe, and leadership can trust the numbers."

The team is designing and building the next generation of our account and ledgering system. We're moving toward an event-oriented financial model where every charge, payment, adjustment, and refund is immutable. Balances get derived from history rather than maintained by hand. Reporting should fall out of the design, not be stitched together afterward.

Your team owns the full money path:

The insurance ledger append-only entries recording payer payments, contractual adjustments, denials, and patient responsibility buckets per procedure, with reversal/refund chains for corrections

Posting and adjustment engines that turn remittances into ledger entries and automatically write off, rebucket, or transfer amounts to patient responsibility based on customer rules

Patient account ledgers tracking balance, payments, credits, and refunds that drive statements, the patient portal, and collections

Bank reconciliation — matching insurer checks to actual bank deposits (via bank APIs, BAI2 files, OCR'd deposit slips) so we only post against verified dollars

Reporting ledger and AR — procedure-level rollups, point-in-time views, AR aging, collections reports, plus drift detection when operational balances disagree with reports

An emerging unified event stream that will become the backbone of a cleaner, replayable ledger architecture

What You’ll Do

Design the next-generation account and ledger model, immutable events, derived balances, clear semantics around payer balance vs. patient balance vs. adjustments vs. cash, with invariants that make it structurally impossible to "print money"

Keep operational balances and financial reports in lockstep. Posting, adjustments, patient balances, rollups, and balance reports need to agree. When they don't, we need drift detection and self-healing

Reconcile three (or four) sources of truth: billed charges, payer remittances, bank deposits, and financial reports. Surface discrepancies before customers do

Scale idempotent, explainable posting and adjustment pipelines across high transaction volumes using negation/reversal semantics instead of mutable edits

Operate money-critical systems on very large Postgres tables, safe migrations, trigger-driven projections, backfills, observability, and incident response where "eventually consistent" isn't acceptable

Set the bar for observability and operational readiness (monitoring, logging, distributed tracing, dashboards, alerting, SLOs, and safe production rollouts) and make sure the team actually lives by it.