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Heat the oil in a skillet over medium heat.
Season the tilapia with salt and pepper.
Add the tilapia to the skillet and sear, flipping once, until just browned on either side, about 1–2 minutes per side.
Remove the tilapia from the skillet.
Add the garlic, ginger, and scallion whites to the same skillet. Cook until fragrant, about 2 minutes.
Add the gochujang and stir, combining it with the aromatics until it begins to brown.
As the gochujang begins to stick to the bottom of the pan, add the coconut milk. Stir to combine.
Add the lime juice and soy sauce and let simmer until thick, about 5 minutes.
Add the tilapia back to the skillet and coat it with the sauce. Simmer until cooked through, about 4 minutes.
Serve, garnished with the reserved scallion greens and cilantro.