Senior IT Systems Engineer

What you’ll be part of 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. 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. About the role: 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. 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. Where you will work: 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. What you will do: 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 The ideal candidate has: 4–7+ years of experience in IT, platform engineering, automation, or similar roles Strong scripting or programming ability in Python, Go, Node.js, 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 What will make you stand out: 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…