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He will replace Scott Lee, who is retiring after 40 years in claims.
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Meco's 2024 gross written premiums totaled $63mn.
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The role will unify the P&C and professional and executive risk practices.
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Fortegra launched a sale process months ago with Barclays and BofA advising.
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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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Technical pricing is insufficient in some areas and inflation is biting into margins.
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It is understood that Marsh brokered the tower, which is exposed to claims from a 2024 breach.
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The deal had HSR approval and was waiting on approval from the UK.
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The broker adds a new EVP and new president to its benefits practice.