This paper examines the structural response of reinforced concrete flat slabs, provided with fully-embedded shear-heads, through detailed three-dimensional nonlinear numerical simulations and parametric assessments using concrete damage plasticity models. Validations of the adopted nonlinear finite element procedures are carried out against experimental results from three test series. After gaining confidence in the ability of the numerical models to predict closely the full inelastic response and failure modes, numerical investigations are carried out in order to examine the influence of key material and geometric parameters. The results of these numerical assessments enable the identification of three modes of failure as a function of the interaction between the shear-head and surrounding concrete. Based on the findings, coupled with results from previous studies, analytical models are proposed for predicting the rotational response as well as the ultimate strength of such slab systems. Practical recommendations are also provided for the design of shear-heads in RC slabs, including the embedment length and section size. The analytical expressions proposed in this paper, based on a wide-ranging parametric assessment, are shown to offer a more reliable design approach in comparison with existing methods for all types of shear-heads, and are suitable for direct practical application.