Melt 2 tablespoons of butter in a large non-stick skillet over medium heat. Add the tilapia fillets and cook for 3–4 minutes on each side, until cooked through and flaky.
Season the fish with salt and pepper. Remove from the skillet and set aside.
In the same pan, melt the remaining 1 tablespoon of butter. Add the diced onion and sauté for about 5 minutes until softened.
Stir in the garlic, chopped roasted peppers, and pureed roasted peppers. Cook for another 5 minutes, allowing flavors to blend.
Add heavy cream and Parmesan cheese. Stir well and let the sauce gently simmer until slightly thickened. Taste and adjust salt if needed.
Return the tilapia to the skillet and spoon the roasted pepper sauce over the fish.
Garnish with chopped parsley and extra Parmesan before serving.