Senior IT Systems Engineer

About this role

<div class="content-intro"><h2><strong>What you’ll be part of</strong></h2> <p>Garner is on a mission to transform the U.S. healthcare system — and we’re 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.</p> <p>The result is a rare “win win” — better care and lower costs for both members and employers. In 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 you've ever wanted your work to solve a problem that touches every person in this country, this is the opportunity to do exactly that. You'd 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.</p></div><h3><strong>About the role:</strong></h3> <p>We are looking for an engineer who can walk into messy, cross-functional workflows and turn them into clean, automated systems that scale. This 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.</p> <p>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 rollout. You will be part of the Business Technology - Corporate Engineering team and report to the Director of Business Technology.</p> <h3><strong>Where you will work:</strong></h3> <p>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. </p> <h3><strong>What you will do:</strong></h3> <ul> <li>Identify and automate high-impact operational workflows across onboarding, offboarding, access management, and service delivery</li> <li>Replace manual, fragmented processes with scalable, API-driven systems</li> <li>Build and maintain integrations across HRIS, identity providers, SaaS platforms, and cloud environments</li> <li>Develop internal tools and automation using platforms like Retool, Okta Workflows, and custom scripts or services</li> <li>Apply infrastructure-as-code to manage and version system configurations</li> <li>Incorporate AI into workflows to improve efficiency in areas like ticket routing, knowledge retrieval, and decision support</li> <li>Design and automate access and security workflows that enforce least-privilege and auditability</li> <li>Own and drive cross-functional initiatives end-to-end, from problem definition through implementation and rollout</li> </ul> <h3><strong>The ideal candidate has:</strong></h3> <ul> <li>4–7+ years of experience in IT, platform engineering, automation, or similar roles</li> <li>Strong scripting or programming ability in Python, Go, Node.js, PowerShell, or similar</li> <li>Experience building API-driven automation across multiple systems</li> <li>Ability to design and implement workflows that span multiple tools and teams</li> <li>Experience with infrastructure-as-code such as Terraform or similar</li> <li>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</li> </ul> <h3>What will make you stand out:</h3> <ul> <li>Hands-on experience with identity and access systems (Okta, SSO, SCIM, RBAC), including implementation and ongoing management</li> <li>Proven ability to build and scale internal tools using platforms like Retool or other low-/no-code solutions</li> <li>Familiarity with security automation and orchestration (e.g., Tines), with an eye toward reducing manual effort and risk</li> <li>Practical experience leveraging AI/LLMs to streamline and enhance operational workflows</li> <li>Strong understanding of compliance and security standards (HIPAA, SOC 2, HITRUST) and how they shape systems and processes</li> <li>Focused on driving meaningful outcomes</li> <li>Able to identify root-cause, system-level issues and design durable solutions rather than quick fixes</li> <li>Comfortable navigating cross-functional environments with competing priorities and constraints</li> <li>Operates with urgency while building scalable, maintainable solutions</li> <li>Defaults to automation and efficiency wherever possible</li> </ul> <h3><strong>Technologies we use: </strong></h3> <ul> <li> <p>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)</p> </li> </ul> <p>This is a unique opportunity to join a fast-growing company in a transformative role, helping shape the future of healthcare.</p> <p><strong>Please note: we…