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Agent guide: [/agents.md](https://www.wearedevelopers.com/agents.md). --- # AI Engineer - **Company:** Mira Mace Medical Services West P.C. - **Location:** San Francisco, CA, United States - **Experience:** Expert - **Contract:** Permanent contract - **Skills:** Artificial Intelligence, Software Debugging, Session Initiation Protocols, Public Switched Telephone Networks, Data Streaming, Twilio, Speech Recognition, Large Language Models, Backend, Speech Synthesis - **Published:** September 20, 2026 - **Apply:** https://www.careerbuilder.com/job-details/senior-ai-engineer-voice-san-francisco-ca--6cfba44b-8d7f-442e-a183-bf718c7d411e ## About the Role * You've built and shipped real-time voice AI to production - not a demo, but a system that took real calls with real people. * Hands-on depth across the voice stack: streaming speech-to-text, text-to-speech, turn detection and endpointing, barge-in, and latency optimization under a real-time budget. * Experience running telephony in production (SIP/PSTN, Twilio or similar) and the failure modes that come with it. * You've built evaluation for voice or conversational systems. * You've debugged AI systems in production and can trace a bad outcome through audio, transcript, and model behavior to the actual cause. * You're comfortable with ambiguity. The playbook doesn't exist yet, and you're excited to build it. NICE TO HAVE * Experience with real-time voice agent frameworks. * Speech model fine-tuning, custom vocabularies, or domain adaptation for specialized terminology. * Experience building agents that navigate automated phone systems on the other end of the line. * Experience in healthcare or another regulated industry (HIPAA, PII/PHI handling, call recording and consent). WHO YOU ARE Beyond technical skills, we're looking for someone who embodies the attributes that make great engineers at an early-stage company: * Proactive. You move quickly and take a forceful stand without being abrasive. You act without being told what to do and bring new ideas to the company. * Analytically sharp. You structure and process qualitative or quantitative data and draw penetrating insights. You learn quickly and absorb new information with ease. * High standards with attention to detail. You expect nothing short of the best from yourself and your team. You don't let important details slip through the cracks or derail a project. * Passionate and open. You exhibit enthusiasm and a can-do attitude over your work. You solicit feedback often and react calmly to criticism or negative feedback., Analysis Skills, Artificial Intelligence (AI), Artificial Intelligence (AI) Agents, Budgeting, Call Volume, DNA, Debugging Skills, Detail Oriented, HIPAA (Health Insurance Portability and Accountability Act), Healthcare, Healthcare Quality, Insurance, Investment Capital, Leadership, Mace Experience, Machine Tool, Medicare, Nursing, PSTN (Public Switched Telephone Network), Product Demonstration, Production Systems, SIP (Session Initiation Protocol), Startup, Telephony, Voice Applications, Voice Mail, Voice Products ## Description Mira Mace pairs Medicare beneficiaries with a dedicated healthcare advocate who navigates appointments, insurance, and care coordination on their behalf. Our customers get the support of caring nurses while AI agents handle the tedious backend work - all covered by Medicare. We've felt the pain ourselves - the endless back-and-forth with insurance, surprise bills, and the lack of clarity when you just need answers. Too many people fall through the cracks, and we're determined to change that. Today, 24/7 personalized health assistance is only available to the rich or extremely sick. Our vision is for everyone to be able to afford a health assistant who knows your health history deeply, navigates the healthcare system on your behalf, and propels you to become the healthiest version of yourself., * Own the voice pipeline. Build and operate the real-time stack - telephony, streaming speech-to-text, LLM orchestration, text-to-speech, endpointing, barge-in, and the latency budget that keeps a conversation feeling human. * Drive call quality relentlessly. Define what a good call is, measure it, and move the number. Build the evaluation harness - replayable audio and transcripts, regression suites, per-turn scoring - so quality changes are provable rather than anecdotal. * Handle the real world. Automated phone menus and DTMF, holds and transfers, voicemail, dropped calls and retries, noisy lines, accents, interruptions, and speaking clearly with an older audience. * Scale calling volume reliably. Make the system hold up across thousands of calls a day, with clean handoffs to a human when the agent should stop. * Close the loop with the people who hear every call. Turn what our team observes on real conversations into prompt, model, and pipeline changes, fast. * Ship fast and iterate with real users. Deploy to production, listen to real conversations, and improve from them - in days, not quarters. * Lay the foundation for scale. Make architectural decisions in the voice stack that hold up from hundreds of calls a day to hundreds of thousands., Everything we do is guided by a set of leadership principles that define how we operate: * Patient First. We start with the patient and work backwards. Every decision - what we build, who we partner with, how we operate - is filtered through one question: does this make the patient's life better? * Sense of Urgency. Every day a patient goes unnavigated is a day someone needing help couldn't get the support they needed. We move fast, make decisions with conviction, and carry urgency toward the long-term vision: an AI nurse concierge in every patient's corner. * Ownership. We see things through. We don't ship and walk away - we own outcomes, not just tasks. We act on behalf of the entire company, beyond just our own area of responsibility. We never say "that's not my job." * Insist on the Highest Standards. We hold ourselves and our teams to nothing short of the best - in clinical quality, in operational execution, in how we show up for patients and partners. We raise the bar continuously. * Question Everything, Unapologetically. We reason from first principles, not precedent. We challenge requirements regardless of who set them, dig until we reach the root of the problem, and resist the pull of "that's how it's always been done." ## Related Videos - [Hello JARVIS - Building Voice Interfaces for Your LLMS](https://www.wearedevelopers.com/videos/1641-hello-jarvis-building-voice-interfaces-for-your-llms) - [20 billion requests a week: Upgrading Twilio's API gateway at scale](https://www.wearedevelopers.com/videos/100234-20-billion-requests-a-week-upgrading-twilio-s-api-gateway-at-scale) - [Python-Based Data Streaming Pipelines Within Minutes](https://www.wearedevelopers.com/videos/1233-python-based-data-streaming-pipelines-within-minutes) - [Developing the Backend with Stefan Lingler, CTO at Shpock](https://www.wearedevelopers.com/videos/100360-developing-the-backend-with-stefan-lingler-cto-at-shpock) - [Raise your voice!](https://www.wearedevelopers.com/videos/10-raise-your-voice) - [Minimal infrastructure for Real‑Time Phone Agents: transcripts in, responses out](https://www.wearedevelopers.com/videos/1736-minimal-infrastructure-for-real-time-phone-agents-transcripts-in-responses-out) ## Related Articles - [Navigating the AI Shift](https://www.wearedevelopers.com/magazine/629-navigating-the-ai-shift) - [How to Become an AI Engineer](https://www.wearedevelopers.com/magazine/331-how-to-become-an-ai-engineer) - [MLOps And AI Driven Development](https://www.wearedevelopers.com/magazine/82-mlops-and-ai-driven-development) - [MLOps – What’s the deal behind it?](https://www.wearedevelopers.com/magazine/125-mlops-what-s-the-deal-behind-it) - [Never delegate the understanding](https://www.wearedevelopers.com/magazine/749-never-delegate-the-understanding) - [Coffee with Developers - Maria Apazoglou - Making AI understandable for all in production](https://www.wearedevelopers.com/magazine/475-coffee-with-developers-maria-apazoglou-making-ai-understandable-for-all-in-production)