Outside of Primus, Alexander has played in several projects with Tool frontman Maynard James Keenan including the bands Puscifer and A Perfect Circle, and also played in the theatrical performance art group Blue Man Group. Alexander has been hailed for his "polyrhythmic" playing.
Before Primus, Alexander played and recorded with Major Lingo, which at the time was a ska-based rhythm band that featured a lap steel guitar as the lead instrument, played by Tony Bruno.
Alexander got the job with Primus replacing Jay Lane (along with Larry LaLonde who replaced Todd Huth) in 1988, and lasted until 1996. Alexander's second stint with Primus was from early 2003 until approximately 2009 when he was replaced by Jay Lane.[citation needed] Les Claypool spoke of Alexander's playing in an interview with Bass Player: "[He] is a very precise player. Even when we're really stretching on something, you can rarely tell that we're still a band that doesn't rehearse much. And a huge part of that is because of Tim".

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