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Hill will replace Frank Sapio in the role.
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He will replace Scott Lee, who is retiring after 40 years in claims.
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The role will unify the P&C and professional and executive risk practices.
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ISA is part of Ryan Specialty National Programs, which launched last month.
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Rouse was promoted to co-global placement leader last October.
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The two internal hires have been with BHSI for around five years.
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Alex Amezquita will fill Cahill’s previous position as CFO.
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The executive has spent over 20 years at Chubb.
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The broker adds a new EVP and new president to its benefits practice.
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The appointments cover US casualty, the US Central region and construction.
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Erik Manning is joining the business from BMS as head of ceded reinsurance.