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Cox was raised in Fairview, Utah. He was appointed to Fairview's city council, and later acted as the city’s mayor. After overseeing rural economic development in Fairview, Cox was elected as a county commissioner for Sanpete County in 2008, and to the Utah House of Representatives in 2012.

On May 14, 2019, Cox announced his intent to seek the Republican nomination for Governor of Utah in 2020.

How did you feel when you heard that 49 people had been gunned down by a self-proclaimed terrorist? That’s the easy question. Here is the hard one: Did that feeling change when you found out the shooting was at a gay bar at 2 a.m. in the morning? If that feeling changed, then we are doing something wrong.

On June 13, 2016, Cox spoke at a vigil in Salt Lake City honoring those who died in the Orlando nightclub shooting the day before. He surprised many when he apologized for mistreating schoolmates and his lack of support for the gay, lesbian, bisexual, and transgender community. He aimed part of his speech at the "straight community":

In October 2015, Cox endorsed Marco Rubio for the Republican Party nomination in the 2016 presidential primary. After Rubio withdrew, Cox endorsed Ted Cruz in March 2016. Of Donald Trump, the front-runner, Cox said: "We care a lot about decorum. We care about our neighbors. We are a good, kind people. He does not represent neither goodness nor kindness." He said he would not support Trump if he wins the Republican nomination: "I think he's disingenuous. I think he's dangerous. I think he represents the worst of what our great country stands for.... I won't vote for Hillary, but I won't vote for Trump, either."

In October 2013, Governor Gary Herbert selected Cox to replace Greg Bell as lieutenant governor, and he was confirmed unanimously by the Utah Senate. Cox has announced that he is running for governor in 2020.

In October 2013, Herbert selected Cox to succeed Bell as lieutenant governor, following Bell's resignation. His nomination was approved unanimously by the Utah Senate's Government Operations Confirmation Committee on October 15. The next day, he was confirmed unanimously by the full Utah Senate and sworn in. As lieutenant governor, Cox's office produced a report on Swallow's financial interests, demonstrating that Swallow had failed to properly disclose all of his income and business interests. Swallow resigned before the release of the report.

Cox was appointed as a city councilor of Fairview, Utah, and elected mayor the next year. In 2008, he was elected as a Sanpete County commissioner. Cox was elected to the Utah House of Representatives in 2012 and became the first member to call for the impeachment of John Swallow, the attorney general of Utah, over violations of laws governing campaign finance. Cox and Lieutenant Governor Bell served as co-chairs of Governor Herbert's Rural Partnership Board.

Spencer James Cox (born July 11, 1975) is an American attorney and politician. A member of the Republican Party, Cox is the eighth lieutenant governor of Utah.